Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation

Marcela Mercado Montoya; Tatiana Gomez Bustamante; Enrique Berjano; Steven R. Mickelsen; James D. Daniels; Pablo Hernandez Arango; Jay Schieber; Erik Kulstad

doi:10.1080/02656736.2022.2121860

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Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation

Journal article

Open access

Peer reviewed

Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation

Marcela Mercado Montoya, Tatiana Gomez Bustamante, Enrique Berjano, Steven R. Mickelsen, James D. Daniels, Pablo Hernandez Arango, Jay Schieber and Erik Kulstad

International journal of hyperthermia, Vol.39(1), pp.1202-1212

12/31/2022

DOI: 10.1080/02656736.2022.2121860

PMCID: PMC9771690

PMID: 36104029

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Abstract

Proactive cooling with a novel cooling device has been shown to reduce endoscopically identified thermal injury during radiofrequency (RF) ablation for the treatment of atrial fibrillation using medium power settings. We aimed to evaluate the effects of proactive cooling during high-power short-duration (HPSD) ablation. A computer model accounting for the left atrium (1.5 mm thickness) and esophagus including the active cooling device was created. We used the Arrhenius equation to estimate the esophageal thermal damage during 50 W/ 10 s and 90 W/ 4 s RF ablations. With proactive esophageal cooling in place, temperatures in the esophageal tissue were significantly reduced from control conditions without cooling, and the resulting percentage of damage to the esophageal wall was reduced around 50%, restricting damage to the epi-esophageal region and consequently sparing the remainder of the esophageal tissue, including the mucosal surface. Lesions in the atrial wall remained transmural despite cooling, and maximum width barely changed (<0.8 mm). Proactive esophageal cooling significantly reduces temperatures and the resulting fraction of damage in the esophagus during HPSD ablation. These findings offer a mechanistic rationale explaining the high degree of safety encountered to date using proactive esophageal cooling, and further underscore the fact that temperature monitoring is inadequate to avoid thermal damage to the esophagus.

Atrial fibrillation

atrioesophageal fistula

esophageal cooling

mathematical modeling

radiofrequency ablation

Details

Title: Subtitle: Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation
Creators: Marcela Mercado Montoya - In Silico Science & Engineering S.A.S
Tatiana Gomez Bustamante - In Silico Science & Engineering S.A.S
Enrique Berjano - Universitat Politècnica de València
Steven R. Mickelsen - University of Iowa
James D. Daniels - The University of Texas Southwestern Medical Center
Pablo Hernandez Arango - In Silico Science & Engineering S.A.S
Jay Schieber - Illinois Institute of Technology
Erik Kulstad - The University of Texas Southwestern Medical Center
Resource Type: Journal article
Publication Details: International journal of hyperthermia, Vol.39(1), pp.1202-1212
DOI: 10.1080/02656736.2022.2121860
PMID: 36104029
PMCID: PMC9771690
NLM abbreviation: Int J Hyperthermia
ISSN: 0265-6736
eISSN: 1464-5157
Publisher: Taylor & Francis
Grant note: name: the National Heart, Lung, And Blood Institute of the National Institutes of Health, award: R44HL158375, RTI2018-094357-B-C21
Language: English
Date published: 12/31/2022
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984359862202771

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