Montoya MM, Mickelsen S, Clark B, Hanks J, Sauter E, Kulstad E, Arnold M (2019)
Publication Type: Journal article
Publication year: 2019
Book Volume: 11
Journal Issue: 5
DOI: 10.4022/jafib.2110
Purpose: We sought to quantify the capabilities of a commercially available cooling device to protect the esophagus from RF injury in an animal model and develop a mathematical model to describe the system and provide a framework from which to advance this technology. Methods: A series of ablations (10 W, duration 30-45 seconds) were performed directly on exposed swine esophagus. Control ablations were performed with static 37°C water, and treatment ablations were performed with water (range 5°C-37°C) circulating within the device. Mucosal lesions were evaluated visually and with target tissue histology. A mathematical model was then developed and compared against the experimental data. Results: All 23 ablations (100%) performed under control conditions produced visible external esophageal lesions; 12 of these (52%) were transmural. Under treatment conditions, only 5 of 23 ablations (22%) produced visible external lesions; none (0%) were transmural. Transmurality of lesions decreased as circulating water temperature decreased, with absolute reduction ranging from 5.1% with the use of 37°C water (p=0.7) to 44.5% with the use of 5°C water (p<0.001). Comparison to the mathematical model showed an R2 of 0.75, representing good agreement. Conclusions: Under worst-case conditions, with RF energy applied directly to the adventitial side of the esophagus, internal esophageal cooling with an esophageal cooling device provides significant protective effect from thermal injury. A mathematical model of the process provides a means to further investigate this approach to preventing esophageal injury during RF ablation and can serve to guide ongoing clinical investigations currently in progress.
APA:
Montoya, M.M., Mickelsen, S., Clark, B., Hanks, J., Sauter, E., Kulstad, E., & Arnold, M. (2019). Protecting the esophagus from thermal injury during radiofrequency ablation with an esophageal cooling device. Journal of Atrial Fibrillation, 11(5). https://doi.org/10.4022/jafib.2110
MLA:
Montoya, Marcela Mercado, et al. "Protecting the esophagus from thermal injury during radiofrequency ablation with an esophageal cooling device." Journal of Atrial Fibrillation 11.5 (2019).
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