Protecting the esophagus from thermal injury during radiofrequency ablation with an esophageal cooling device

Marcela Mercado Montoya, Steven Mickelsen, Brad Clark, Martin Arnold, Joseph Hanks, Eric Sauter, Erik Kulstad

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalJournal of Atrial Fibrillation
Volume11
Issue number5
StatePublished - Feb 1 2019

Fingerprint

Esophagus
Theoretical Models
Hot Temperature
Equipment and Supplies
Water
Wounds and Injuries
Adventitia
Water Purification
Histology
Swine
Animal Models
Technology
Temperature
Therapeutics

Keywords

  • Ablation
  • Atrial Fibrillation
  • Esophageal Cooling
  • Esophageal Protection
  • Finite Element Model
  • Mathematical Modeling
  • Pulmonary Vein Isolation
  • Radiofrequency Energy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Protecting the esophagus from thermal injury during radiofrequency ablation with an esophageal cooling device. / Montoya, Marcela Mercado; Mickelsen, Steven; Clark, Brad; Arnold, Martin; Hanks, Joseph; Sauter, Eric; Kulstad, Erik.

In: Journal of Atrial Fibrillation, Vol. 11, No. 5, 01.02.2019.

Research output: Contribution to journalArticle

Montoya, Marcela Mercado ; Mickelsen, Steven ; Clark, Brad ; Arnold, Martin ; Hanks, Joseph ; Sauter, Eric ; Kulstad, Erik. / Protecting the esophagus from thermal injury during radiofrequency ablation with an esophageal cooling device. In: Journal of Atrial Fibrillation. 2019 ; Vol. 11, No. 5.
@article{7327fa9be02c472cb77cb19edf4093fe,
title = "Protecting the esophagus from thermal injury during radiofrequency ablation with an esophageal cooling device",
abstract = "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.",
keywords = "Ablation, Atrial Fibrillation, Esophageal Cooling, Esophageal Protection, Finite Element Model, Mathematical Modeling, Pulmonary Vein Isolation, Radiofrequency Energy",
author = "Montoya, {Marcela Mercado} and Steven Mickelsen and Brad Clark and Martin Arnold and Joseph Hanks and Eric Sauter and Erik Kulstad",
year = "2019",
month = "2",
day = "1",
language = "English (US)",
volume = "11",
journal = "Journal of Atrial Fibrillation",
issn = "1941-6911",
publisher = "Cardiofront, Inc.",
number = "5",

}

TY - JOUR

T1 - Protecting the esophagus from thermal injury during radiofrequency ablation with an esophageal cooling device

AU - Montoya, Marcela Mercado

AU - Mickelsen, Steven

AU - Clark, Brad

AU - Arnold, Martin

AU - Hanks, Joseph

AU - Sauter, Eric

AU - Kulstad, Erik

PY - 2019/2/1

Y1 - 2019/2/1

N2 - 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.

AB - 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.

KW - Ablation

KW - Atrial Fibrillation

KW - Esophageal Cooling

KW - Esophageal Protection

KW - Finite Element Model

KW - Mathematical Modeling

KW - Pulmonary Vein Isolation

KW - Radiofrequency Energy

UR - http://www.scopus.com/inward/record.url?scp=85067579234&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067579234&partnerID=8YFLogxK

M3 - Article

VL - 11

JO - Journal of Atrial Fibrillation

JF - Journal of Atrial Fibrillation

SN - 1941-6911

IS - 5

ER -