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Unexpected High Incidence of Esophageal Injury Following Pulmonary Vein Isolation Using Robotic Navigation

2010; Wiley; Volume: 21; Issue: 8 Linguagem: Inglês

10.1111/j.1540-8167.2010.01742.x

1540-8167

Roland Richard Tilz, K.R. Julian Chun, Andreas Metzner, A. Burchard, Erik Wißner, Buelent Koektuerk, Melanie Konstantinidou, Dieter Nuyens, Tom De Potter, Kars Neven, Alexander Fuernkranz, Feifan Ouyang, Boris Schmidt,

Mechanical Circulatory Support Devices

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 degrees 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 degrees C. Endoscopy was carried out 2 days post-ablation.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.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 degrees C significantly reduced the risk of esophageal injury.