Abstract
BackgroundEsophageal 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.ResultsThe model predicts that the esophageal cooling device, even with body-temperature 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.ConclusionsAn 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.
Highlights
Esophageal thermal injury can occur after radiofrequency (RF) ablation in the left atrium to treat atrial fibrillation
The sweep of the parameter values (RF power and cooling temperature) resulted in multiple simulations to study the influence of those parameters in the maximum or peak temperature, the lesion depth and the fraction of damage for up to 20 s of ablation
The esophageal lesion depth was defined as the distance from the pericardium–esophagus interface to the farthest point along the line perpendicular to the catheter tip crossing the ablated tissues, which results in a fraction of damage over 2%
Summary
Esophageal thermal injury can occur after radiofrequency (RF) ablation in the left atrium to treat atrial fibrillation. A new esophageal heat transfer device currently available for whole-body cooling or warming may offer an additional option to prevent esophageal injury. A whole-body temperature management device that operates through the esophagus (EnsoETM, Attune Medical, Chicago, IL, USA) became commercially available in 2015, and is being investigated for its potential to counteract unintended esophageal heating during RF ablation of the left atrium [12]. In order to further investigate the potential of this new approach, and quantify the possible efficacy, we sought to develop a mathematical model of this process and evaluate performance over a range of expected operating conditions while comparing output to recently available clinical data
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