An Insight to the Role of Thermal Effects on the Onset of Atrioesophageal Fistula: A Computer Model of Open-Irrigated Radiofrequency Ablation

摘要

Purpose-Atrial fibrillation (AF) is the most common heart rhythm disorder in the world. Radiofrequency catheter ablation (RFCA) has become the preferred method of treatment for drug-refractory AF. One of the rare (< 0.2) but deadly (=80) complications of RFCA is Atrioesophageal fistula (AEF). Although the exact patho-physiological events in developing AEF are not fully understood, one hypothesis is that the underlying cause may be thermal damage to the mucosa (the esophagus lumen). Method-The present study reports on a computer model of RFCA in the posterior wall of the left atrium (LA) which is in close proximity to the esophagus. A novel systematic approach was taken by considering a range of anatomical variations (obtained from clinical data) to study the spatial and temporal temperature data when RF energy was applied to cause a threshold temperature of 50 °C in the mucosa. The model is also used to investigate the spatial and temporal changes in mucosal temperature that may affect the reliability of the readings from esophageal temperature monitoring devices if they are not positioned accurately.