Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis
Por:
Leung, LWM, Gallagher, MM, Santangeli, P, Tschabrunn, C, Guerra, JM, Campos, B, Hayat, J, Atem, F, Mickelsen, S, Kulstad, E
Publicada:
1 nov 2020
Ahead of Print:
1 nov 2019
Resumen:
Purpose Thermal damage to the esophagus is a risk from radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF). The most extreme type of thermal injury results in atrio-esophageal fistula (AEF) and a correspondingly high mortality rate. Various strategies for reducing esophageal injury have been developed, including power reduction, esophageal deviation, and esophageal cooling. One method of esophageal cooling involves the direct instillation of cold water or saline into the esophagus during RF ablation. Although this method provides limited heat-extraction capacity, studies of it have suggested potential benefit. We sought to perform a meta-analysis of published studies evaluating the use of esophageal cooling via direct liquid instillation for the reduction of thermal injury during RF ablation. Methods We searched PubMed for studies that used esophageal cooling to protect the esophagus from thermal injury during RF ablation. We then performed a meta-analysis using a random effects model to calculate estimated effect size with 95% confidence intervals, with an outcome of esophageal lesions stratified by severity, as determined by post-procedure endoscopy. Results A total of 9 studies were identified and reviewed. After excluding preclinical and mathematical model studies, 3 were included in the meta-analysis, totaling 494 patients. Esophageal cooling showed a tendency to shift lesion severity downward, such that total lesions did not show a statistically significant change (OR 0.6, 95% CI 0.15 to 2.38). For high-grade lesions, a significant OR of 0.39 (95% CI 0.17 to 0.89) in favor of esophageal cooling was found, suggesting that esophageal cooling, even with a low-capacity thermal extraction technique, reduces the severity of lesions resulting from RF ablation. Conclusions Esophageal cooling reduces the severity of the lesions that may result from RF ablation, even when relatively low heat extraction methods are used, such as the direct instillation of small volumes of cold liquid. Further investigation of this approach is warranted, particularly with higher heat extraction capacity techniques.
Filiaciones:
Leung, LWM:
St Georges Univ London, St Georges Univ Hosp NHS Fdn Trust, Dept Cardiol, Cranmer Terrace, London SW17 0RE, England
Gallagher, MM:
St Georges Univ London, St Georges Univ Hosp NHS Fdn Trust, Dept Cardiol, Cranmer Terrace, London SW17 0RE, England
Santangeli, P:
Univ Penn, Perelman Sch Med, 3400 Civ Ctr Blvd, Philadelphia, PA 19104 USA
Tschabrunn, C:
Univ Penn, Perelman Sch Med, 3400 Civ Ctr Blvd, Philadelphia, PA 19104 USA
Guerra, JM:
Univ Autonoma Barcelona, CIBERCV, Hosp Santa Creu & St Pau, Carrer St Quinti 89, Barcelona 08041, Spain
Campos, B:
Univ Autonoma Barcelona, CIBERCV, Hosp Santa Creu & St Pau, Carrer St Quinti 89, Barcelona 08041, Spain
Hayat, J:
St Georges Univ London, St Georges Univ Hosp NHS Fdn Trust, Dept Gastroenterol, Cranmer Terrace, London SW17 0RE, England
Atem, F:
UT Southwestern Med Ctr, Dept Neurol & Neurotherapeut, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
Mickelsen, S:
Univ Iowa, Dept Internal Med, Carver Coll Med, 200 Hawkins Dr, Iowa City, IA 52242 USA
Kulstad, E:
UT Southwestern Med Ctr, Dept Emergency Med, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
Green Accepted, Hybrid Gold, Green Published
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