Unexpected high incidence of esophageal injury following pulmonary vein isolation using robotic navigation.
BACKGROUND
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.


RESULTS
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.


CONCLUSIONS
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.
Tilz
Roland R
RR
Department of Cardiology, Asklepios Klinik St. Georg, Med. Klinik, 5 Lohmühlenstrasse, Hamburg, Germany.
Chun
K R Julian
KR
Metzner
Andreas
A
Burchard
Andre
A
Wissner
Erik
E
Koektuerk
Buelent
B
Konstantinidou
Melanie
M
Nuyens
Dieter
D
De Potter
Tom
T
Neven
Kars
K
Fürnkranz
Alexander
A
Ouyang
Feifan
F
Schmidt
Boris
B
D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects*; D004939:Esophageal Perforation / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014456:Ulcer / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology