监测心房颤动导管消融术后的食管损伤。

IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Interventional Cardiac Electrophysiology Pub Date : 2024-10-22 DOI:10.1007/s10840-024-01922-8
Alberto Pereira Ferraz, Cristiano Faria Pisani, Esteban Wisnivesky Rocca Rivarola, Tan Chen Wu, Francisco Carlos da Costa Darrieux, Rafael Alvarenga Scanavacca, Carina Abigail Hardy, Muhieddine Omar Chokr, Denise Tessariol Hachul, Maurício Ibrahim Scanavacca
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引用次数: 0

摘要

目的:心房颤动(房颤)消融术后的心房食管瘘仍是一个主要问题。目前还没有标准化的方法来最大限度地降低这一严重并发症的风险和发病率。本研究旨在介绍房颤导管消融术后系统性内镜监测食管损伤的 7 年经验:这是一项回顾性单中心登记,对 2016 年至 2022 年连续进行房颤消融术后的系统性内镜评估进行登记:在此期间,共分析了 677 例房颤消融手术,并进行了受控食管胃十二指肠镜检查(EGD)。大多数患者为男性(71%),阵发性房颤(71%)。633名患者(93.5%)的主要消融方法是射频消融和电解剖图绘制。220 名患者(34.3%)使用单传感器进行食管温度监测,296 名患者(46%)使用多传感器探头进行食管温度监测。大多数患者没有食管病变(75.7%)。其中 46 名患者(6.8%)出现严重病变(堪萨斯城市分级 KCC 2B),需要在 7 天内重新进行胃肠造影检查。有 3 名患者的 KCC2B 病变持续存在,其中 2 人在愈合过程中出现溃疡,1 名患者的溃疡深达 10 毫米,需要入院接受禁食和肠外营养治疗。溃疡在术后第二周愈合。两种食管温度监测策略在预防热损伤方面效果相当。此外,左心房(LA)越大,食管溃疡发生率越低(P = 0.028)。大多数病变可自行愈合:结论:消融术后食管损伤的发生率为 24.3%。结论:消融术后食管损伤发生率为 24.3%,大部分(72%)为轻微损伤,无需治疗干预。左心房(LA)越大,热损伤的发生率越低。早期内镜检查有助于诊断严重的食管病变,并可为房颤消融术后食管损伤的监测提供更多信息。
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Surveillance of esophageal injury after atrial fibrillation catheter ablation.

Aims: Atrial-esophageal fistula following ablation procedures for atrial fibrillation (AF) remains a major concern. There is no standardized approach to minimize the risk and morbidity of this serious complication. The objective of this study was to present the 7-year experience of systematic endoscopic surveillance of esophageal injury after AF catheter ablation.

Methods: This was a retrospective single-center registry of systematic endoscopic evaluations after consecutive AF ablation procedures performed from 2016 to 2022.

Results: A total of 677 AF ablation procedures with controlled esophagogastroduodenoscopy (EGD) were analyzed during that period. Most patients were male (71%) with paroxysmal AF (71%). Radiofrequency with electroanatomical mapping was the main ablation approach for 633 patients (93.5%). Esophageal temperature monitoring was performed using a single sensor in 220 patients (34.3%) and a multisensor probe in 296 patients (46%). Most of the patients presented no esophageal lesions (75,7%). Severe lesions (Kansas-city-classification KCC 2B) were found in 46 (6.8%) of them, requiring a new EGD in 7 days. KCC2B lesions were persistent in 3 patients, 2 of whom had ulcers during healing and 1 patient with a deep ulcer of 10 mm who was admitted to the hospital and underwent fasting and parenteral nutrition. The ulcer healed in the second week after the procedure. Both esophageal temperature monitoring strategies were equivalent at preventing thermal lesions. Additionally, a greater left atrium (LA) was associated with a lower incidence of esophageal ulcer (P = 0.028). Most of the lesions spontaneously healed.

Conclusion: The incidence of esophageal injury after ablation was 24.3%. Most (72%) were mild lesions that required no therapeutic intervention. A larger left atrium (LA) was correlated with a lower incidence of thermal lesions. Early endoscopy can help diagnose severe esophageal lesions and may provide additional information for the surveillance of esophageal injury after AF ablation.

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来源期刊
CiteScore
4.30
自引率
11.10%
发文量
320
审稿时长
4-8 weeks
期刊介绍: The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.
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