Paroxysmal Atrial Fibrillation
Conditions
Keywords
Cryoballoon Pulmonary Vein Isolation, Esophageal Effects
Brief summary
To determine the correlation between rate of temperature decline and nadir cryoballoon temperatures rate of temperature decline and nadir esophageal temperatures during pulmonary vein isolation.
Detailed description
When treating atrial fibrillation and targeting various areas in the left atrium, electrophysiologists have the choice to perform ablation with RF energy or cryoenergy. Esophageal ulceration and in more rare cases, esophageal fistulae, are known complications of this ablation procedure. Though rare (0.1-0.25% fistula rate and 15-20% esophageal ulceration rate according to the most recent Heart Rhythm Society EHRA ECA consensus statement)1, the investigators would very much like to understand how to completely prevent these occurrences. Cryoenergy has more recently been introduced as an energy source used in the PVI procedure; therefore, for this energy source, rates of esophageal ulceration are not yet well-defined. Nine esophageal fistulae have occurred in the first approximately 130,000 cryoballoon procedures.
Interventions
PROCEDUREEsophageal Temperature-Guided Ablation
Esophageal temperature-guided ablation (if esophageal temperatures drop too low during cryoablation, the physician will stop the ablation) in order to increase the safety profile of cryoballoon pulmonary vein (a vein carrying blood from the participants lungs to the left side of the participants heart known as the left atrium) isolation (PVI \[means a balloon shaped catheter will be placed at the opening of each pulmonary vein and tissue will be cooled in order to create an ablation line (line of scar tissue) between the left side of the participants heart and each pulmonary vein. This is done to prevent the triggers that typically cause intermittent atrial fibrillation (known as Paroxsymal Atrial Fibrillation) by providing one center's experience.
Sponsors
Baylor Research Institute
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Recurrent, symptomatic, drug-refractory, paroxysmal atrial fibrillation with planned cryoballoon pulmonary vein isolation 2. Age \>18 years 3. Planned AF cryoablation procedure
Exclusion criteria
1. LA diameter \>55mm 2. Severe LVH (LV wall ≥ 15mm) 3. LA thrombus 4. Decompensated heart failure 5. Plans for left atrial ablation lesions beyond isolation of the pulmonary veins 6. History of previous pulmonary vein isolation 7. Inability to place esophageal temperature probe or TEE probe 8. Previously documented phrenic nerve injury 9. Known esophageal pathology (complete GI history worksheet)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Temperature Decline | 90 days or when complications resolve | I. To determine the correlation between rate of temperature decline and nadir cryoballoon temperatures rate of temperature decline and nadir esophageal temperatures during pulmonary vein isolation procedure. |
| Measurements of esophagus to each pulmonary vein | 90 days or when complications resolve | II. To accurately measure the distance between the esophagus and the ostium of each pulmonary vein intra-operatively. |
| Create Recommendations for esophageal temperature-guided ablation | 90 days or when complications resolve | To attempt to create recommendations for esophageal temperature-guided ablation in order to increase the safety profile of cryoballoon pulmonary vein isolation (PVI) by providing one center's experience. By trending cryoballoon ablation temperatures and subsequent esophageal temperatures, data trends may emerge and be predictive for esophageal ulceration formation. These trends may include: * Distance between esophagus and pulmonary vein in patients who developed post-ablation esophageal ulcerations * Intra-procedure esophageal temperatures in patients who developed post-ablation esophageal ulcerations * Intra-procedure cryoballoon temperatures in patients who developed post-ablation esophageal ulcerations |
| Assessment of additional Adverse Events | 90 days or when complications resolve | To associate the development of symptoms (including dysphagia, chest pain, fever, heartburn, or odynophagia) with the presence of ulcerations. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Data collection on Phrenic Injury | 90 days or when complications resolve | Assess participants with abnormal imaging and/or adverse events that are related to the treatment. |
Outcome results
None listed