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Abstract 10771: Avoidance of Lethal Isotherm Formation in Esophageal Tissue with an Active Cooling Device Under High-Power, Short-Duration Ablation

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Abstract

10771: Avoidance of Lethal Isotherm Formation in Esophageal Tissue with an Active Cooling Device Under High-Power,… https://www.ahajournals.org/ Abstract Introduction: Atrioesophageal fistula (AEF) is a severe complication of left atrial ablation for the treatment of atrial fibrillation. Thermal injury is the proposed mechanism, and a potential pathway occurs through exceeding the lethal isotherm of esophageal tissue in contact with the left atrial posterior wall. Active cooling with a novel cooling device has been shown to significantly reduce thermal injury, with no AEFs encountered after more than 4200 treatments worldwide. We aimed to evaluate the effects of active cooling when specifically using newer high-power short-duration (HPSD) ablation settings to further estimate the protective mechanisms of this novel approach to reduce serious injury.
11/22/21, 9:24 AM
Abstract 10771: Avoidance of Lethal Isotherm Formation in Esophageal Tissue with an Active Cooling Device Under High-Power,
https://www.ahajournals.org/doi/10.1161/circ.144.suppl_1.10771
1/2
ELECTROPHYSIOLOGY AND ARRHYTHMIAS
SESSION TITLE: AF ABLATION
Abstract 10771: Avoidance of Lethal Isotherm Formation in
Esophageal Tissue with an Active Cooling Device Under High-
Power, Short-Duration Ablation
Marcela Mercado Montoya, Enrique Berjano, Steven R Mickelsen, James D Daniels, Tatiana Gomez-Bustamante,
Pablo Hernandez-Arango, Erik Kulstad
Abstract
Introduction: Atrioesophageal fistula (AEF) is a severe complication of left atrial ablation for the
treatment of atrial fibrillation. Thermal injury is the proposed mechanism, and a potential pathway
occurs through exceeding the lethal isotherm of esophageal tissue in contact with the left atrial
posterior wall. Active cooling with a novel cooling device has been shown to significantly reduce
thermal injury, with no AEFs encountered after more than 4200 treatments worldwide. We aimed to
evaluate the effects of active cooling when specifically using newer high-power short-duration (HPSD)
ablation settings to further estimate the protective mechanisms of this novel approach to reduce
serious injury.
Hypothesis: Active cooling may preclude attainment of a lethal isotherm in esophageal tissue under
HPSD ablation.
Methods: We developed a model of the left atrium and esophagus, and simulated radiofrequency
(RF) ablation of the left atrium under HPSD settings. Tissue thickness was set to typical posterior-wall
parameters (Figure). Power settings were evaluated at 50 W for 10 seconds, and 90 W for 4 seconds.
Active cooling was set to a typical 4 °C coolant temperature. Lethal isotherm temperature was taken
as 50 °C.
Results: In both scenarios of HPSD ablation, the peak esophageal mucosal temperature reached 39°
C in control conditions, using no active cooling. With active cooling in place, peak temperatures
remained below 11 °C (Figure). Peak temperatures at the epi-esophageal region of esophageal tissue
exceeded the lethal isotherm of 50 °C in control conditions, but remained at or below the lethal
isotherm with active cooling in place.
Conclusions: Based on our mathematical modeling, esophageal cooling significantly reduced
temperature rise and prevented the achievement of temperatures thought to be lethal to esophageal
tissue. This finding may offer a mechanistic rationale for the absence of serious esophageal injury
encountered to date using this approach.
Originally published 8 Nov 2021 Circulation. 2021;144:A10771
11/22/21, 9:24 AM
Abstract 10771: Avoidance of Lethal Isotherm Formation in Esophageal Tissue with an Active Cooling Device Under High-Power,
https://www.ahajournals.org/doi/10.1161/circ.144.suppl_1.10771
2/2
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