Esophageal Protective Devices for Catheter Ablation: Changes in the Relevant Anatomical Structures
Notice bibliographique
Résumé
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia in North America and is a major risk factor for stroke, congestive heart failure, and death. An increasingly popular first line of treatment is a minimally invasive procedure called radiofrequency catheter ablation (RFA) which mainly targets the pulmonary veins of the left atrium (LA). This procedure boasts high success rates, but in rare cases, patients may develop a fatal atrial esophageal fistula (AEF). Esophageal protective devices may mitigate the risk of developing a fistula but their effects on the anatomical structures within the posterior mediastinum are not well understood. The primary objective of our study is to evaluate the changes in the esophagus‐left atrium relationship with the insertion of an esophageal protective device. Methods Using 13 fresh cadaveric torsos we performed computed tomography (CT) scans prior to the insertion of a novel esophageal protective device (pre‐scan) and while the device was inserted in the esophageal lumen (post‐scan). The width of the esophagus, anterior‐posterior dimension, and the distance from the centerline of the esophagus to the left atrial pericardium were measured and compared between pre‐scans (no device) and post‐scans (device inserted). An additional standardizing measurement was taken between the vertebral column and the left atrium (VC‐LA) to evaluate the extent of heart displacement with the insertion of the device. Lastly, the shortest esophagus‐left atrial distance was marked by a point and mapped to previously defined regions of the LA after 3D reconstruction of the esophagus and LA. Measurements were performed using digital calipers in Mimics®. Preliminary Results A paired t‐test between VC‐LA measurements (n = 8) revealed no significant differences between pre‐ and post‐scans indicating that the insertion of the device does not move the heart dramatically. A Wilcoxon signed‐rank test was used to evaluate the differences in the mean esophageal widths between scans (n = 5). Of these 5 specimens, 3 demonstrated significant widening of the esophagus with device insertion (p< .001), 1 demonstrated significant esophageal narrowing (p< .001), and 1 demonstrated no significant differences in esophageal width. Data collection is ongoing. Discussion/Conclusion Preliminary data indicates that the position of the heart is not significantly affected by the insertion of the device. Thus, our esophagus to left atrial measurement will be indicative of changes in the position of the esophagus relative to the stationary heart. Preliminary esophageal width data revealed significant widening in 3 specimens while the device was inserted, which we expect will decrease the anterior‐posterior dimension of the esophagus. Future data on the shortest esophagus‐pericardial relationship will allow us to determine positional changes in the esophagus between pre‐ and post‐scans. In conclusion, data from this novel study will provide an anatomical basis for the design and implementation of an esophageal protective device used in catheter ablation procedures in order to effectively mitigate the risk of developing an AEF. This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».