Proactive esophageal cooling during laser cardiac ablation: A computer modeling study

IF 2.2 3区医学 Q2 DERMATOLOGY

Lasers in Surgery and Medicine Pub Date : 2024-03-04 DOI:10.1002/lsm.23774

Tatiana Gomez Bustamante BSc, Marcela Mercado Montoya MSc, Enrique Berjano PhD, Ana González-Suárez PhD, Erik Kulstad MS

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Abstract

Background and Objectives

Laser ablation is increasingly used to treat atrial fibrillation (AF). However, atrioesophageal injury remains a potentially serious complication. While proactive esophageal cooling (PEC) reduces esophageal injury during radiofrequency ablation, the effects of PEC during laser ablation have not previously been determined. We aimed to evaluate the protective effects of PEC during laser ablation of AF by means of a theoretical study based on computer modeling.

Methods

Three-dimensional mathematical models were built for 20 different cases including a fragment of atrial wall (myocardium), epicardial fat (adipose tissue), connective tissue, and esophageal wall. The esophagus was considered with and without PEC. Laser-tissue interaction was modeled using Beer–Lambert's law, Pennes' Bioheat equation was used to compute the resultant heating, and the Arrhenius equation was used to estimate the fraction of tissue damage (FOD), assuming a threshold of 63% to assess induced necrosis. We modeled laser irradiation power of 8.5 W over 20 s. Thermal simulations extended up to 250 s to account for thermal latency.

Results

PEC significantly altered the temperature distribution around the cooling device, resulting in lower temperatures (around 22°C less in the esophagus and 9°C in the atrial wall) compared to the case without PEC. This thermal reduction translated into the absence of transmural lesions in the esophagus. The esophagus was thermally damaged only in the cases without PEC and with a distance equal to or shorter than 3.5 mm between the esophagus and endocardium (inner boundary of the atrial wall). Furthermore, PEC demonstrated minimal impact on the lesion created across the atrial wall, either in terms of maximum temperature or FOD.

Conclusions

PEC reduces the potential for esophageal injury without degrading the intended cardiac lesions for a variety of different tissue thicknesses. Thermal latency may influence lesion formation during laser ablation and may play a part in any collateral damage.

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激光心脏消融过程中的主动食管冷却：计算机建模研究

背景和目的：激光消融越来越多地用于治疗心房颤动（房颤）。然而，食道损伤仍是一种潜在的严重并发症。虽然主动食管冷却（PEC）可减少射频消融过程中的食管损伤，但激光消融过程中 PEC 的效果尚未确定。我们的目的是通过基于计算机建模的理论研究，评估 PEC 在房颤激光消融过程中的保护作用：建立了 20 个不同病例的三维数学模型，包括心房壁（心肌）、心外膜脂肪（脂肪组织）、结缔组织和食道壁的片段。考虑了食管有无 PEC 的情况。使用比尔-朗伯定律模拟激光与组织的相互作用，使用潘尼斯生物热方程计算加热结果，使用阿伦尼乌斯方程估算组织损伤率（FOD），假定评估诱导坏死的阈值为 63%。我们模拟了 20 秒内 8.5 W 的激光照射功率。热模拟延长至 250 秒，以考虑热潜伏期：结果：与无 PEC 的情况相比，PEC 明显改变了冷却装置周围的温度分布，导致温度降低（食管温度降低约 22°C，心房壁温度降低约 9°C）。这种热量的降低导致食管没有出现跨壁病变。只有在食管与心内膜（心房壁的内边界）之间的距离等于或小于 3.5 mm 的情况下，食管才会受到热损伤。此外，无论是就最高温度还是就 FOD 而言，PEC 对穿越心房壁产生的病变影响都很小：结论：对于各种不同厚度的组织，PEC 可降低食管损伤的可能性，而不会降低预期的心脏病变。热潜伏期可能会影响激光消融过程中病灶的形成，并可能对任何附带损伤产生影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lasers in Surgery and Medicine 医学-外科

CiteScore

5.40

自引率

12.50%

发文量

119

审稿时长

1 months

期刊介绍： Lasers in Surgery and Medicine publishes the highest quality research and clinical manuscripts in areas relating to the use of lasers in medicine and biology. The journal publishes basic and clinical studies on the therapeutic and diagnostic use of lasers in all the surgical and medical specialties. Contributions regarding clinical trials, new therapeutic techniques or instrumentation, laser biophysics and bioengineering, photobiology and photochemistry, outcomes research, cost-effectiveness, and other aspects of biomedicine are welcome. Using a process of rigorous yet rapid review of submitted manuscripts, findings of high scientific and medical interest are published with a minimum delay.