Clinical Study On The Application Value Of Transesophageal Echocardiography In Atrial Fibrillation Cryoballoon Ablation

Objective:Atrial fibrillation?AF?is the most common arrhythmia.At present,the main methods of pulmonary vein isolation are radiofrequency catheter ablation and cryoba-lloon ablation.Transesophageal Echocardiography?TEE?is a commonly used means of imaging examination,before catheter ablation of AF is mainly used for specific pre-operative atrial and there are no thrombosis in the auricle.In this study,patients with paroxysmal atrial fibrillation were treated with pulmonary vein isolation by TEE gui-ded cryoballoon ablation,which was compared with the patients without TEE guided cryoballoon ablation.Through the observation of clinical cases,the application value of TEE in cryoballoon ablation was discussed.Methods:A total of 71 patients with paroxysmal atrial fibrillation who met the indica-tions of cryocatheter ablation were enrolled on April 1,2016,solstice,November30,2019,excluding those with organic heart disease,tumor,history of cardiac surgery,thyroid dysfunction,congenital heart disease,and the presence of pulmonary vein trunk or pulmonary vein branches.The prospective,randomized controlled method was used to divide the patients into two groups,among which 36 patients received TEE guided cryoballoon ablation to guide the balloon to block pulmonary vein and evaluate the blocking effect.In addition,before cryoballoon ablation begins,the TEE probe is operated to move the esophagus away from the pulmonary vein vestibule where freezing is to be performed.35 patients underwent cryoballoon ablation without TEE.Clinical information of the patients was collected:age,gender,duration of atrial fibrillation,left atrial size,left ventricular ejection fraction,CHA₂DS₂-VASc score,whether patients had hypertension,coronary heart disease,diabetes,etc.The operative time,freezing time,X-ray exposure time,amount of contrast agent and esophageal movement distance were recorded.Patients received oral anticoagulants?dabigatran,rivaroxaban,or warfarin?for no less than 2 months and proton pump inhibitors for 8weeks.Three months after the operation was defined as the blank period,during which antiarrhythmic drugs were applied according to the patient's condition.Discontinuation of all antiarrhythmic drugs after 3 months.Follow-up was conducted at the 1st,3rd,6th and 12th months after the operation,and 24-hour dynamic electrocardiogram was perfor-med to observe whether atrial fibrillation recurred and its complications occurred.The clinical application value of TEE in the treatment of paroxysmal atrial fibrillation by cryoballoon ablation was discussed.Results:1.All 71 patients successfully completed the cryoballoon ablation without intraoperative complications.Among them,61.9%were men.The baseline data of the two groups of patients:there was no statistical difference in gender,age,duration of atrial fibrillation,left atrial diameter,left ventricular ejection fraction,and CHA₂DS₂-VASc score between the TEE group and the no TEE group?P>0.05?.2.The total operation time of all patients was 108.5min±40min.The operation time of pulmonary vein occlusion?112.6min±42.3min vs 104.4min±36.7min,P=0.61?and the time of cryoballoon ablation?LSPV:315.6s±52.4s vs 317.6s±43.8s,P=0.32;LIPV:289.4s±67.8s vs 299.8s±78.9s,P=0.47;RSPV:312.1s±81.5s vs 321.4s±76.2s,P=0.52;RIPV:321.6s±77.3s vs 322.6s±87.6s,P=0.43?in the TEE group and the no TEE group,there was no significant statistical difference.3.In all 71 patients,the X-ray exposure time?13.3min±2.1min vs 21.8min±5.2 min,P<0.05?and the dose of contrast agent?7.4m L±5.6m L vs 17.3m L±3.5m L,P<0.05?in the TEE group were both lower than those in the no TEE group,showing statistical significance.4.All patients were followed up.During the mean follow-up period of13.0minths±3.3 months,the success rate of TEE group and no TEE group was similar?80.6%vs 79.4%,P=0.64?,and no complications such as atrial esophageal fistula and pulmonary vein stenosis occurred during the follow-up period.5.Among the 36 patients in the TEE group,the esophagus of 6 patients was located in the middle of the posterior wall of the left atrium,which was far from the left pulmonary vein and the right pulmonary vein,so the TEE probe was not displaced during the cryoballoon ablation.In another 30 patients,the esophagus was close to the left pulmonary vein and was displaced by TEE during cryoballoon ablation.The average distance of TEE probe during LSPV ablation was 2.0cm±0.1cm?1.8cm-2.3cm?,and that during LIPV ablation was 2.1cm±0.2cm?1.8cm-2.5 cm?.Conclusion:This study found that TEE is feasible in the clinical application of cryoballoon ablation.The amount of contrast agent and X-ray exposure time can be reduced without affecting the success rate and operation time.At the same time,TEE can move the position of the esophagus away from the cryoballoon ablation,which may have the potential value of reducing the risk of esophageal injury.