AIM:To investigate the luminal esophageal temperature(LET) at the time of delivery of energy for pulmonary vein isolation(PVI).METHODS:This study included a total of 110 patients with atrial fibrillation who underwent...AIM:To investigate the luminal esophageal temperature(LET) at the time of delivery of energy for pulmonary vein isolation(PVI).METHODS:This study included a total of 110 patients with atrial fibrillation who underwent their first PVI procedure in our laboratory between March 2010 and February 2011.The LET was monitored in all patients.We measured the number of times that LET reached the cut-off temperature,the time when LET reached the cut-off temperature,the maximum temperature(T max) of the LET,and the time to return to the original preenergy delivery temperature once the delivery of energy was stopped.RESULTS:Seventy-eight patients reached the cut-off temperature.It took 6 s at the shortest time for the LET to reach the cut-off temperature,and 216.5 ± 102.9 s for the temperature to return to the level before the de-livery of energy.Some patients experienced a transient drop in the LET(TDLET) just before energy delivery.Ablation at these sites always produced a rise to the LET cut-off temperature.TDLET was not observed at sites where the LET did not rise.Thus,the TDLET before the energy delivery was useful to distinguish a high risk of esophageal injury before delivery of energy.CONCLUSION:Sites with a TDLET before energy delivery should be ablated with great caution or,perhaps,not at all.展开更多
Introduction: Atrio-esophageal fistula is a rare but often fatal complication of radiofrequency ablation for atrial fibrillation. Here we report a successful case in anesthetic management of surgical repair of atrio-e...Introduction: Atrio-esophageal fistula is a rare but often fatal complication of radiofrequency ablation for atrial fibrillation. Here we report a successful case in anesthetic management of surgical repair of atrio-esophageal fistula. Case Report: The patient was a 56-year-old man status post radiofrequency ablation for atrial fibrillation one month before presenting with fever and symptoms and signs of cerebral emboli. He was diagnosed as having atrio-esophageal fistula, which required emergent surgical repair. In the operating room, rapid sequence induction was performed with avoidance of positive pressure ventilation before securing airway. Double lumen tube was used for lung isolation for left thoracotomy. Upon exploration, a small fistula was identified. Both atrial and esophageal defects were ligated and an intercostal muscle flap was placed. The patient’s heart rhythm was atrial flutter/atrial fibrillation with marginal hemodynamics during the procedure, but cardioversion was delayed until the fistula was repaired and no remaining air, blood clot or gastric content in the heart was confirmed by epicardial ultrasound. The patient tolerated the surgery and was transferred to ICU, intubated and ventilated. He recovered from surgery and was transferred to a rehabilitation hospital with residual expressive aphasia. Conclusion: We had a successful case in anesthetic management for surgical repair of atrio-esophageal fistula by preventing massive bleeding as well as multiple air embolization through the fistula.展开更多
文摘AIM:To investigate the luminal esophageal temperature(LET) at the time of delivery of energy for pulmonary vein isolation(PVI).METHODS:This study included a total of 110 patients with atrial fibrillation who underwent their first PVI procedure in our laboratory between March 2010 and February 2011.The LET was monitored in all patients.We measured the number of times that LET reached the cut-off temperature,the time when LET reached the cut-off temperature,the maximum temperature(T max) of the LET,and the time to return to the original preenergy delivery temperature once the delivery of energy was stopped.RESULTS:Seventy-eight patients reached the cut-off temperature.It took 6 s at the shortest time for the LET to reach the cut-off temperature,and 216.5 ± 102.9 s for the temperature to return to the level before the de-livery of energy.Some patients experienced a transient drop in the LET(TDLET) just before energy delivery.Ablation at these sites always produced a rise to the LET cut-off temperature.TDLET was not observed at sites where the LET did not rise.Thus,the TDLET before the energy delivery was useful to distinguish a high risk of esophageal injury before delivery of energy.CONCLUSION:Sites with a TDLET before energy delivery should be ablated with great caution or,perhaps,not at all.
文摘Introduction: Atrio-esophageal fistula is a rare but often fatal complication of radiofrequency ablation for atrial fibrillation. Here we report a successful case in anesthetic management of surgical repair of atrio-esophageal fistula. Case Report: The patient was a 56-year-old man status post radiofrequency ablation for atrial fibrillation one month before presenting with fever and symptoms and signs of cerebral emboli. He was diagnosed as having atrio-esophageal fistula, which required emergent surgical repair. In the operating room, rapid sequence induction was performed with avoidance of positive pressure ventilation before securing airway. Double lumen tube was used for lung isolation for left thoracotomy. Upon exploration, a small fistula was identified. Both atrial and esophageal defects were ligated and an intercostal muscle flap was placed. The patient’s heart rhythm was atrial flutter/atrial fibrillation with marginal hemodynamics during the procedure, but cardioversion was delayed until the fistula was repaired and no remaining air, blood clot or gastric content in the heart was confirmed by epicardial ultrasound. The patient tolerated the surgery and was transferred to ICU, intubated and ventilated. He recovered from surgery and was transferred to a rehabilitation hospital with residual expressive aphasia. Conclusion: We had a successful case in anesthetic management for surgical repair of atrio-esophageal fistula by preventing massive bleeding as well as multiple air embolization through the fistula.
