Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation
- PDF / 5,266,169 Bytes
- 17 Pages / 595.276 x 790.866 pts Page_size
- 1 Downloads / 162 Views
BioMedical Engineering OnLine Open Access
RESEARCH
Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions Marcela Mercado1* , Lisa Leung2, Mark Gallagher2, Shailee Shah3 and Erik Kulstad4 *Correspondence: marcela.mercado@udea. edu.co 1 Bioengineering Department, Engineering Faculty, Universidad de Antioquia UdeA, Calle 70 No. 52‑21, Medellin, Colombia Full list of author information is available at the end of the article
Abstract Background: Esophageal thermal injury can occur after radiofrequency (RF) ablation in the left atrium to treat atrial fibrillation. Existing methods to prevent esophageal injury have various limitations in deployment and uncertainty in efficacy. A new esophageal heat transfer device currently available for whole-body cooling or warming may offer an additional option to prevent esophageal injury. We sought to develop a mathematical model of this process to guide further studies and clinical investigations and compare results to real-world clinical data. Results: The model predicts that the esophageal cooling device, even with bodytemperature water flow (37 °C) provides a reduction in esophageal thermal injury compared to the case of the non-protected esophagus, with a non-linear direct relationship between lesion depth and the cooling water temperature. Ablation power and cooling water temperature have a significant influence on the peak temperature and the esophageal lesion depth, but even at high RF power up to 50 W, over durations up to 20 s, the cooling device can reduce thermal impact on the esophagus. The model concurs with recent clinical data showing an 83% reduction in transmural thermal injury when using typical operating parameters. Conclusions: An esophageal cooling device appears effective for esophageal protection during atrial fibrillation, with model output supporting clinical data. Analysis of the impact of ablation power and heart wall dimensions suggests that cooling water temperature can be adjusted for specific ablation parameters to assure the desired myocardial tissue ablation while keeping the esophagus protected. Keywords: Atrial fibrillation, Radiofrequency ablation, Esophageal protection, Finite element model, Mathematical modeling, Esophageal cooling, Ablation parameters
Background Esophageal injury is known to occur during ablation of the left atrium with radiofrequency (RF) energy, and the extreme outcome of this injury, atrio-esophageal fistula, may occur in up to 0.25% of patients [1, 2]. Cooling the esophagus during RF ablation has © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are
Data Loading...
