Incidence Of Esophageal Lesions Research Articles

Efficacy and safety of high-power short-duration ablation for atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.

High-power short-duration (HPSD) ablation has emerged as an alternative to conventional standard-power long-duration (SPLD) ablation. We aim to assess the efficacy and safety of HPSD versus SPLD for atrial fibrillation (AF) ablation. A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL were performed through August 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). CRD42023471797. We included six RCTs with a total of 694 patients. HPSD was significantly associated with a decreased total procedure time (MD: -22.88 with 95% CI [-36.13, -9.63], P = 0.0007), pulmonary vein isolation (PVI) time (MD: -19.73 with 95% CI [-23.93, -15.53], P < 0.00001), radiofrequency time (MD: -10.53 with 95% CI [-12.87, -8.19], P < 0.00001). However, there was no significant difference between HPSD and SPLD ablation with respect to the fluoroscopy time (MD: -0.69 with 95% CI [-2.00, 0.62], P = 0.30), the incidence of esophageal lesions (RR: 1.15 with 95% CI [0.43, 3.07], P = 0.77), and the incidence of first pass isolation (RR: 0.98 with 95% CI [0.88, 1.08], P = 0.65). HPSD ablation was significantly associated with decreased total procedure time, PVI time, and radiofrequency time compared with SPLD ablation. On the contrary, SPLD ablation was significantly associated with low maximum temperature.

AB-452654-1 ESOPHAGEAL PROTECTION STRATEGIES FOR ABLATION OF ATRIAL FIBRILLATION: COMPARATIVE RESULTS BASED ON CONSECUTIVE ENDOSCOPIC EVALUATION

Catheter ablation is an effective treatment for restoring sinus rhythm in AF and has become a worldwide procedure. Although rare, atrioesophageal fistula (AEF) is among the most common lethal complications of this procedure. Several strategies have been employed to prevent esophageal lesions, including single and multi-sensor esophageal probes, different energy strategies, esophageal displacement and regular esophageal monitoring using esophagogastroduodenoscopy (EGD) to identify asymptomatic esophageal lesions that could evolve to AEF. As the occurrence of AEF is rare, one of the approaches to evaluate which strategy is more effective in preventing esophageal lesions is studying the incidence of asymptomatic on routine endoscopy. The objective of this study is to present the five-year experience of a systematic endoscopic surveillance of esophageal injury after AF catheter ablation and analyse if there is an appropriate strategy related to a lower incidence of lesions. This is a retrospective single center registry of all AF ablation procedures performed from 2016 to 2021, in which an endoscopy was performed after ablation in all cases. A total of 660 AF ablation procedures in 626 different patients were performed in that period. A control EGD data could be recorded in 609 ablation procedures (92,3%). Most of the patients were male with paroxysmal AF. Esophageal temperature monitoring with single Sensor Probe was performed in 48.4% and with multi–sensor probe in 24.4% of the cases. Most of the patients presented no esophageal lesions (71.8%). Mild lesion was found on 90 patients (14.8%) and severe lesion was found on 56 (9.2%) of them. The use of multisensor esophageal probe (P<0.001), male gender (P=0.007) and the use of PVAC (P=0.018) were correlated with less frequent thermal lesions on multivariate analysis. Most of the lesions were healed on control endoscopy. The incidence of esophageal lesions on routine EGD after AF catheter ablation is high, but most of the cases the lesion is spontaneously healed. The use of multisensor probe, PVAC and male gender were correlated to fewer thermal lesions.

1246High-power and short-duration radiofrequency ablation for atrial fibrillation: feasibility, safety and one-year results

Abstract Funding Acknowledgements SEC-Bayer research project 2018, Spanish Society of Cardiology. Research project 2018, FIS, Insituto de Salud Carlos III. OnBehalf none Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than cryoablation. In addition, it is associated with more oesophageal lesions. The aim of this study was to evaluate the feasibility, safety and 1-year efficacy of PVI by high power short duration (HPSD) PPRF in patients with atrial fibrillation (AF). METHODS PPRF around the PV was performed in 125 patients (P) distributed in two groups. Conventional PPRF with 30W/≤30 s under luminal oesophageal temperature monitoring was performed in the first 47 P (Group 1). 68 P were enrolled in the HPSD (Group 2). Power was set to 50 W and delivered to reach a predefined lesion index value (LSI≥5 or AI≥350) in the first 18 P (Group 2A). 30 P underwent PPRF with 60 W for 7-10 s (Group 2B) and the last 30 P underwent PPRF with 70W for 9 s (Group 2C). Oesophageal endoscopy was performed after ablation in all P. RESULTS 17 (36%) P in Group 1 and 30 (38%) in Group 2 had persistent AF. PVI of all targeted veins was achieved in 96% and 100% of P in both groups (p = 0,6). Total RF time was 30 [27-42], 25[ 20-29], 16 [14-20] and 13 [11-16] in Groups 1, 2A, 2B and 2C respectively (p &amp;lt; 0.01). RF duration per target lesions was 12[9-17], 9[8-9] and 9[9-9] s in Groups 2A, 2B and 2C respectively (p &amp;lt; 0.001). First-pass PVI was achieved in 35% 56%, 57% and 85% of left PV circles (p &amp;lt; 0.001) and in 46%, 56%, 60% and 82% of right PV circles (p = 0.04) in groups 30W, 50W, 60W and 70W respectively. Reconnections occurred in 8% of PV circles in Group 1 and in 6.5% of PV circles in Group 2 (p = 0.8). Dormant conduction was tested with adenosine in Groups 2B and 2C and the incidence was 30% and 25% of PV circles respectively (p = 0.31). The carina was the most frequent location of conduction gaps, reconnections and dormant conduction in all groups. The incidence of oesophageal lesions was 28% in Group 1, 22% in Group 2A and 0% in groups 2B and 2C (p &amp;lt; 0.002). The 1-year efficacy (freedom from any atrial tachycardia recurrences &amp;gt;30 s) was 59% in Group 1, 88% in group 2A, 77% in group 2B and 87% in group 2C (p = 0.019). CONCLUSIONS PVI by HPSD PPRF is feasible and results in high 1-year efficacy in P with AF. This approach appears safe and associated with low incidence of oesophageal damage especially when short application time and 60 or 70W are used. However, this latter power setting is associated with slightly better 1-year efficacy than HPSD PPRF using 60W. Abstract Figure. Recurrences of atrial arrhythmias (&amp;gt;30 s

Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: short-term results of the POWER-FAST PILOT study.

Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than that achieved by single-shot ablation techniques. In addition, it is associated with significant risk of oesophageal injury. The POWER-FAST pilot study evaluated the feasibility and safety of PVI by high-power short-duration (HPSD) PPRF. HPSD PPRF around the PVs was done in 48 consecutive patients with atrial fibrillation. Fifty watts was delivered until a predefined lesion index value was reached (LSI ≥ 5 or Abl-I ≥ 350) and 60 W during 7-10 s in the first 18 and last 30 patients, respectively. A control group of 47 consecutive patients who had undergone PVI before the HPSD group with conventional PPRF (30 W for 30 s) was included for reference. Echocardiography and oesophageal endoscopy was performed shortly after ablation in all patients. PVI of all targeted veins was achieved in 98% and 100% of patients of the conventional and HPSD groups, respectively (p = 0.59). Total radiofrequency time was 34 ± 11, 24 ± 8, and 15 ± 5 min in groups 30 W, 50 W, and 60 W (p < 0.001). Audible steam pops occurred in 4 out of 48 (8%) patients in the HPSD group, accounting for 4 (0.08%) out of 5 269 HPSD radiofrequency applications. No patient in the HPSD group developed pericardial effusion. The incidence of oesophageal lesions was 28%, 22%, and 0% in groups 30 W, 50 W, and 60 W, respectively (p = 0.007) CONCLUSIONS: PVI can be achieved with HPSD PPRF in most patients. This approach appears safe and associated with low risk of esophageal damage.

6122Pulmonary vein isolation by different setting of high-power short-duration radiofrequency application: feasibility, short term efficacy and safety in patients with atrial fibrillation

Abstract Aims Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than cryoballoon ablation. In addition, it is associated with more esophageal lesions. The aim of this study was to evaluate the feasibility and safety of PVI by high power short duration (HPSD) PPRF in patients with atrial fibrillation. Methods PPRF around the PVs was done in 125 consecutive patients distributed in two chronologically successive groups. Conventional PPRF with 30W for ≤30 s under luminal esophageal temperature monitoring was performed in the first 47 patients (Group 1). 68 patients were enrolled in the HPSD (Group 2). Power was set to 50 W and delivered to reach a predefined lesion index value (LSI ≥5 or Abl-I ≥350) in the first 18 patients (Group 2A). 30 patients underwent PPRF with 60W for 7–10 s (Group 2B) and the last 30 patients underwent PPRF with 70W for 9 s (Group 2C). Esophageal endoscopy was performed after ablation in all patients. Results PVI of all targeted veins was achieved in 96% and 100% of patients of groups 1 and 2 respectively (p=0.6). Total RF time was 30 [27–43], 25 [20–29], 16 [14–20] and 14 [11–16] min in groups 1, 2A and 2B and 2C respectively (p&lt;0.001). RF was delivered for 12 [9–17] s vs 9 [8–9]s vs 9 [8–9] per application in groups 2 A, 2B and 2C respectively (p&lt;0.001). Total number of RFa to completely isolate all PV was 105 [90–126] in group 2A, 113 [90–135] in group 2B and 94 [79–112] in group 2C (p=0.12). First-pass PVI was achieved in 56%, 57% and 85% of left PV (p=0.038) and in 56%, 60% and 82% of right PV (p=0.13) in groups 50W, 60W and 70W respectively. The carina was the most frequent location of persistent conduction when first-pass failed. Reconnections occurred in 6%, 3% and 11% of left PV (p=0.6) and in 6%, 7% and 4% (p=0.63) of right PV in groups 50W, 60W and 70W respectively. Adenosine test was systematically used in groups 60W and 70W: the incidence of dormant conduction was 23% and 22% (p=0.9) in left PV and 20% and 22% (p=0.8) in right PV respectively. The incidence of esophageal lesions was 28% in Group 1, 2% in Group 2A, and 0% in groups 2B and 2C (p&lt;0.001). No other intraprocedural complications occurred in the high-power group. Total RF time Conclusions PVI is feasible with HPSD PPRF in most patients using shorter total RF times. This approach appears associated with very low incidence esophageal damage than the conventional one, especially when 60W/70W and shorter application time are used. Acknowledgement/Funding Grant of the Spanish Society of Cardiology

Incidence of esophageal lesions in patients undergoing ablation for atrial fibrillation with multipolar pulmonary vein ablation catheter (PVAC-GOLD®)

Incidence of esophageal lesions in patients undergoing ablation for atrial fibrillation with multipolar pulmonary vein ablation catheter (PVAC-GOLD®)

Prevention of oesophageal injury during catheter ablation of atrial fibrillation: is monitoring of oesophageal temperature the solution?

This editorial refers to ‘Oesophageal temperature monitoring and incidence of oesophageal lesions after pulmonary vein isolation using a remote robotic navigation system’ by A. Rillig et al. , Europace 2010;12:655–61. Atrio-oesophageal fistula is among the most dangerous complications of interventional treatment of atrial fibrillation. The complication was first observed during intraoperative radiofrequency ablation of atrial fibrillation1 but subsequently also reported after catheter based radiofrequency ablation of atrial fibrillation.2 Atrio-oesophageal fistula is associated with high mortality3 even if the correct diagnosis is made relatively early. However, the diagnosis of the complication often is delayed because of the significant time delay of its occurrence after the ablation procedure (which mostly is 1–4 weeks) and unspecific initial symptoms.3,4 The mechanism most likely leading to atrio-oesophageal fistula after radiofrequency ablation of atrial fibrillation is the induction of thermal oesophageal injury during the ablation procedure; this pathophysiologic pathway could recently be observed in a patient who declined intervention after diagnosis of atrio-oesophageal fistula.4 The incidence of oesophageal injury after radiofrequency ablation of atrial fibrillation has been described between 5% and almost 50%5–7 depending on the radiofrequency power settings and ablation strategies. After the initial injury of the oesophagus, inflammation, and tissue necrosis promoted by the biological milieu in the oesophagus seem to pave the way for the occurrence of atrio-esophagel fistula. However, it is unclear which factors determine the progression of the frequently observed oesophageal lesion to the relatively rare but …

Oesophageal temperature monitoring and incidence of oesophageal lesions after pulmonary vein isolation using a remote robotic navigation system

Oesophageal lesions (EL), a potential complication after pulmonary vein isolation (PVI), have been described recently. A new remote robotic navigation system (RNS; Hansen Medical) provides enhanced catheter stability along with more effective lesion placement. The aim of this prospective study was to evaluate temperature monitoring and incidence of EL when using RNS with an irrigated tip radiofrequency catheter for PVI. Circumferential PVI using RNS was performed in 73 patients (pts) with paroxysmal (n = 46, 63%) and persistent atrial fibrillation. An oesophageal temperature probe was placed in 58 (79.5%) pts and was integrated in the 3D-map (NavX). Power was limited to 25 W at the posterior wall, and in the case of an increase in temperature power was limited to 20 W. Endoscopy was performed in 42 pts within 24 h after PVI. In 44 of 58 (75.9%) pts, a significant rise in temperature (>39 degrees C) was observed. In 6 of 42 (14.3%) pts, an EL was found during endoscopy. In patients with EL, the body mass index (BMI) was significantly lower than in pts without EL (24.1 +/- 2.0 vs. 29.0 +/- 5.8, P = 0.047). The BMI of all patients with EL was <26, whereas all patients without EL had a BMI above 26. The EL showed brisk healing after re-endoscopy within 2 weeks in all pts. In patients undergoing PVI using the RNS, the incidence of EL is 14.3% when using power settings comparable to settings used in manual ablation. Patients with lower BMI (<26) are at higher risk for EL.

Homeostatic Role of Transforming Growth Factor-β in the Oral Cavity and Esophagus of Mice and Its Expression by Mast Cells in These Tissues

Transforming growth factor-beta (TGF-beta) is a pleiotropic growth factor; its overexpression has been implicated in many diseases, making it a desirable target for therapeutic neutralization. In initial safety studies, mice were chronically treated (three times per week) with high doses (50 mg/kg) of a murine, pan-neutralizing, anti-TGF-beta antibody. Nine weeks after the initiation of treatment, a subset of mice exhibited weight loss that was concurrent with decreased food intake. Histopathology revealed a unique, nonneoplastic cystic epithelial hyperplasia and tongue inflammation, as well as dental dysplasia and epithelial hyperplasia and inflammation of both the gingiva and esophagus. In an effort to determine the cause of this site-specific pathology, we examined TGF-beta expression in these tissues and saliva under normal conditions. By immunostaining, we found higher expression levels of active TGF-beta1 and TGF-beta3 in normal tongue and esophageal submucosa compared with gut mucosal tissues, as well as detectable TGF-beta1 in normal saliva by Western blot analysis. Interestingly, mast cells within the tongue, esophagus, and skin co-localized predominantly with the TGF-beta1 expressed in these tissues. Our findings demonstrate a novel and restricted pathology in oral and esophageal tissues of mice chronically treated with anti-TGF-beta that is associated with basal TGF-beta expression in saliva and by mast cells within these tissues. These studies illustrate a previously unappreciated biological role of TGF-beta in maintaining homeostasis within both oral and esophageal tissues.

顎口腔領域癌患者における上部消化管内視鏡検査（ＧＩＦ）の検討

We investigated the relation of oral and maxillofacial cancer to upper gastrointestinal fiberscopic findings and evaluated the value and reliability of gastrointestinal fiberscopy (GIF). Sixty-two patients with oral and maxillofacial squamous cell carcinoma were examined by GIF in consultation with an internist.The results were as follows:1. The incidence of upper gastrointestinal lesions in patients with oral and maxillofacial cancer was higher than that in the general population.2. There was no relation between the region or the stage of squamous cell carcinoma and the incidence of upper gastrointestinal lesions.3. There were 6 cases (9.7%) of double cancer. There were also many precancerous lesions, such as esophageal dysplasia (3 cases, 4.8%), Barret's mucosa (3 cases, 4.8%), atrophic gastritis (26 cases, 41.9%), and intestinal metaplasia (9 cases, 14.5%). Four cases of active peptic ulcer (6.5%) were also found.4. The incidence of esophageal lesions in patients with smoking and drinking habits was significantly higher than that in patients without smoking habits, drinking habits, or both.In conclusion, it is important to examine the upper gastrointestinal tract of patients with oral and maxillofacial cancer by GIF not only to screen for double cancers but also to detect precancerous lesions and active peptic ulcers.

Effect of age and sex on lesions of the esophagus in Buffalo strain rats ingesting diethylnitrosamine.

Inbred Buffalo male and female rats, 4, 12, 24, and 52 weeks of age, ingested 0.0114% diethylnitrosamine in a semisynthetic diet. Both age and sex were important in the development of preneoplastic and neoplastic lesions of the esophagus. The 4-week-old male rats had notably more carcinomas of the esophagus than female rats of the same age; whereas, 12-week-old male rats had only slightly more carcinomas than the females. The incidence of esophageal lesions was about the same in 24-week-old males and females. Rats 52 weeks of age were not susceptible to esophageal carcinogenesis.

Autopsy findings in the upper gastrointestinal tract of 81 burn patients. A review.

A review of autopsy findings over a ten-year period in the gastrointestinal tract of 81 burn patients has been carried out. Erosive lesions were found in 46.9% of the cases, with frank ulcers in 23.5%. Esophageal lesions were present in 18.5%, gastric lesions in 27.7%, and duodenal lesions in 11.1%. The incidence of frank ulceration was 7.4% in the esophagus, 11.1% in the stomach, and 8.6% in the duodenum. The total percentage of erosive lesions found in the series is high, and it is postulated that increasing survival time may be responsible for this. The majority of the reported cases (54) were children under 15 years of age and the high ulcer incidence observed in this age group by other authors was found in this series. The incidence of esophageal lesions is unusually high and this may relate to the widespread use of Levin tubes.