Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation
Background Proactive cooling with a novel cooling device has been shown to reduce endoscopically identified thermal injury during radiofrequency (RF) ablation for the treatment of atrial fibrillation using medium power settings. We aimed to evaluate the effects of proactive cooling during high-power...
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Taylor & Francis Group
2022-12-01
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| Series: | International Journal of Hyperthermia |
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| Online Access: | https://www.tandfonline.com/doi/10.1080/02656736.2022.2121860 |
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| author | Marcela Mercado Montoya Tatiana Gomez Bustamante Enrique Berjano Steven R. Mickelsen James D. Daniels Pablo Hernandez Arango Jay Schieber Erik Kulstad |
| author_facet | Marcela Mercado Montoya Tatiana Gomez Bustamante Enrique Berjano Steven R. Mickelsen James D. Daniels Pablo Hernandez Arango Jay Schieber Erik Kulstad |
| author_sort | Marcela Mercado Montoya |
| collection | DOAJ |
| description | Background Proactive cooling with a novel cooling device has been shown to reduce endoscopically identified thermal injury during radiofrequency (RF) ablation for the treatment of atrial fibrillation using medium power settings. We aimed to evaluate the effects of proactive cooling during high-power short-duration (HPSD) ablation.Methods A computer model accounting for the left atrium (1.5 mm thickness) and esophagus including the active cooling device was created. We used the Arrhenius equation to estimate the esophageal thermal damage during 50 W/ 10 s and 90 W/ 4 s RF ablations.Results With proactive esophageal cooling in place, temperatures in the esophageal tissue were significantly reduced from control conditions without cooling, and the resulting percentage of damage to the esophageal wall was reduced around 50%, restricting damage to the epi-esophageal region and consequently sparing the remainder of the esophageal tissue, including the mucosal surface. Lesions in the atrial wall remained transmural despite cooling, and maximum width barely changed (<0.8 mm).Conclusions Proactive esophageal cooling significantly reduces temperatures and the resulting fraction of damage in the esophagus during HPSD ablation. These findings offer a mechanistic rationale explaining the high degree of safety encountered to date using proactive esophageal cooling, and further underscore the fact that temperature monitoring is inadequate to avoid thermal damage to the esophagus. |
| format | Article |
| id | doaj-art-ff2e741a99f840a899a288075ef973e2 |
| institution | Kabale University |
| issn | 0265-6736 1464-5157 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | International Journal of Hyperthermia |
| spelling | doaj-art-ff2e741a99f840a899a288075ef973e22025-08-20T03:51:24ZengTaylor & Francis GroupInternational Journal of Hyperthermia0265-67361464-51572022-12-013911202121210.1080/02656736.2022.2121860Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablationMarcela Mercado Montoya0Tatiana Gomez Bustamante1Enrique Berjano2Steven R. Mickelsen3James D. Daniels4Pablo Hernandez Arango5Jay Schieber6Erik Kulstad7In Silico Science & Engineering S.A.S, Medellin, ColombiaIn Silico Science & Engineering S.A.S, Medellin, ColombiaBioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, SpainElectrophysiology Department, University of Iowa, Iowa City, USAElectrophysiology Department, University of Texas Southwestern Medical Center, Dallas, TX, USAIn Silico Science & Engineering S.A.S, Medellin, ColombiaDepartments of Chemical Engineering, Physics, and Applied Mathematics, Illinois Institute of Technology, Chicago, IL, USAElectrophysiology Department, University of Texas Southwestern Medical Center, Dallas, TX, USABackground Proactive cooling with a novel cooling device has been shown to reduce endoscopically identified thermal injury during radiofrequency (RF) ablation for the treatment of atrial fibrillation using medium power settings. We aimed to evaluate the effects of proactive cooling during high-power short-duration (HPSD) ablation.Methods A computer model accounting for the left atrium (1.5 mm thickness) and esophagus including the active cooling device was created. We used the Arrhenius equation to estimate the esophageal thermal damage during 50 W/ 10 s and 90 W/ 4 s RF ablations.Results With proactive esophageal cooling in place, temperatures in the esophageal tissue were significantly reduced from control conditions without cooling, and the resulting percentage of damage to the esophageal wall was reduced around 50%, restricting damage to the epi-esophageal region and consequently sparing the remainder of the esophageal tissue, including the mucosal surface. Lesions in the atrial wall remained transmural despite cooling, and maximum width barely changed (<0.8 mm).Conclusions Proactive esophageal cooling significantly reduces temperatures and the resulting fraction of damage in the esophagus during HPSD ablation. These findings offer a mechanistic rationale explaining the high degree of safety encountered to date using proactive esophageal cooling, and further underscore the fact that temperature monitoring is inadequate to avoid thermal damage to the esophagus.https://www.tandfonline.com/doi/10.1080/02656736.2022.2121860Atrial fibrillationradiofrequency ablationatrioesophageal fistulaesophageal coolingmathematical modeling |
| spellingShingle | Marcela Mercado Montoya Tatiana Gomez Bustamante Enrique Berjano Steven R. Mickelsen James D. Daniels Pablo Hernandez Arango Jay Schieber Erik Kulstad Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation International Journal of Hyperthermia Atrial fibrillation radiofrequency ablation atrioesophageal fistula esophageal cooling mathematical modeling |
| title | Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation |
| title_full | Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation |
| title_fullStr | Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation |
| title_full_unstemmed | Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation |
| title_short | Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation |
| title_sort | proactive esophageal cooling protects against thermal insults during high power short duration radiofrequency cardiac ablation |
| topic | Atrial fibrillation radiofrequency ablation atrioesophageal fistula esophageal cooling mathematical modeling |
| url | https://www.tandfonline.com/doi/10.1080/02656736.2022.2121860 |
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