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- Title
Unexpected High Incidence of Esophageal Injury Following Pulmonary Vein Isolation Using Robotic Navigation.
- Authors
TILZ, ROLAND R.; CHUN, K. R. JULIAN; METZNER, ANDREAS; BURCHARD, ANDRE; WISSNER, ERIK; KOEKTUERK, BUELENT; KONSTANTINIDOU, MELANIE; NUYENS, DIETER; DE POTTER, TOM; NEVEN, KARS; FUERNKRANZ, ALEXANDER; OUYANG, FEIFAN; SCHMIDT, BORIS
- Abstract
Esophageal Injury Following Robotic Navigation. Introduction: Robotic navigation (RN) is a novel technology for pulmonary vein isolation (PVI). We investigated the incidence of thermal esophageal injury using RN with commonly used power settings in comparison to manual PVI procedures. Methods: Thirty-nine patients underwent circumferential PVI using a 3.5-mm irrigated-tip-catheter. In the manual (n = 25) and the RN1 group (n = 4) power was limited to 30 W (17 mL/min flow, maximal temperature 43°C, max. 30 sec/spot) at the posterior left atrial (LA) wall. In RN-based procedures, ablation was performed with a contact force of 10–40 g. The operator was blinded to the esophageal temperature (Teso). In the RN2 group ablation power along the posterior LA wall was reduced to 20 W and ablation terminated at Teso of 41°C. Endoscopy was carried out 2 days postablation. Results: PVI was achieved in all patients. In the manual group no esophageal lesions, minimal lesions, or ulcerations were found in 15 of 25 (60%), 7 of 25 (28%), and 3 of 25 (12%) patients, respectively. All patients in the RN1 group had an ulceration and one developed esophageal perforation. A covered stent was placed 14 days post-PVI and removed at day 81. In the RN2 group, only a single minimal lesion was found. Conclusions: A high incidence of thermal esophageal injury including a perforation was noted following robotic PVI using 30 W along the posterior LA wall. During RN-based PVI procedures esophageal temperature monitoring is advocated. Reduction of ablation power to 20 W and termination of energy delivery at Teso of 41°C significantly reduced the risk of esophageal injury. (J Cardiovasc Electrophysiol, Vol. 21, pp. 853-858, August 2010)
- Subjects
ATRIAL fibrillation treatment; ESOPHAGEAL injuries; ESOPHAGEAL perforation; ANALYSIS of variance; CATHETER ablation; ENDOSCOPY; PULMONARY veins; ROBOTICS; STATISTICS; DATA analysis
- Publication
Journal of Cardiovascular Electrophysiology, 2010, Vol 21, Issue 8, p853
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/j.1540-8167.2010.01742.x