Abstract
Background
Despite luminal esophageal temperature (LET) monitoring, esophageal injury remains a risk which impacts decision making during atrial fibrillation (AF) ablation. We sought to compare procedural characteristics including radiofrequency (RF) power, duration, and LET, among ablation procedures with and without image segmentation for esophageal visualization (EV).
Methods
The retrospective cohort included 73 patients (mean age 65.2 ± 8.6 years, 36% female, 55% paroxysmal AF) who underwent pre-procedural cardiac magnetic resonance or computed tomography and LET monitoring. Of all patients, 35 were historical patients that underwent standard AF ablation without EV, and 38 were contemporary patients, 28 of whom underwent AF ablation with EV and 10 that underwent AF ablation without EV.
Results
Total RF time was similar between the groups. The distribution of ablation power delivery was skewed toward higher power in the contemporary patients. However, among patients in the contemporary group, the proportion of > 35 Watts lesions was lower with EV (P < 0.001). There was no difference between the max or mean LET. The standard deviation of LET change within patient during posterior wall ablation was lower in those with esophageal visualization compared to historical controls, but no change was seen compared to a smaller group of contemporary controls. No long-term clinical esophageal injury was observed.
Conclusions
In a retrospective analysis, EV was successfully performed in 28 patients. EV impacted RF power delivery decisions but was unassociated with RF time, changes in LET, or long-term safety.
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Funding
This work was supported by the Mark Marchlinski EP Research and Education Fund and indirectly by NIH R01HL142893 awarded to Dr. Nazarian.
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The source cohort was approved by the University of Pennsylvania institutional review committee, and all patients gave informed consent for the use of clinical, imaging, and procedural data for medical research before the procedure.
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Dr. Nazarian is a consultant for CardioSolv and Circle CVI; and principal investigator for research funding from Biosense Webster, ImriCor, Siemens, and ADAS software. The University of Pennsylvania Conflict of Interest Committee manages all commercial arrangements. The other authors report no conflicts of interest.
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Khoshknab, M., Zghaib, T., Xu, L. et al. Esophageal image segmentation for guidance of posterior wall lesions during atrial fibrillation ablation. J Interv Card Electrophysiol 65, 543–550 (2022). https://doi.org/10.1007/s10840-022-01307-9
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DOI: https://doi.org/10.1007/s10840-022-01307-9