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Unexpected High Incidence of Esophageal Injury Following Pulmonary Vein Isolation Using Robotic Navigation
Author(s) -
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
Publication year - 2010
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2010.01742.x
Subject(s) - medicine , perforation , ablation , pulmonary vein , catheter ablation , surgery , catheter , endoscopy , nuclear medicine , materials science , punching , metallurgy
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 RN 1 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 (T eso ). In the RN 2 group ablation power along the posterior LA wall was reduced to 20 W and ablation terminated at T eso 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 RN 1 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 RN 2 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 T eso of 41°C significantly reduced the risk of esophageal injury. (J Cardiovasc Electrophysiol, Vol. 21, pp. 853‐858, August 2010)