Esophageal pressure monitoring for airway management during catheter ablation of atrial fibrillation

Abstract

Background: Respiratory management during catheter ablation of atrial fibrillation (AF) is important for the efficacy and safety of the procedure. Obstructive apnea due to an upper airway obstruction might cause serious complications including air embolisms and cardiac tamponade. However, real time monitoring of upper airway obstructions during catheter ablation has not been established. The purpose of the present study was to evaluate esophageal pressure monitoring for respiratory management during catheter ablation of AF.

Methods and results: Twenty-four consecutive patients (20 men and 4 women; mean age, 61 ± 13 years) with AF who underwent esophageal pressure monitoring during catheter ablation of AF were retrospectively analyzed. The patients were divided into 2 groups. One was the obstructive apnea (OA) group (n = 17), which required airway management tools including nasal airways and/or non-invasive positive airway pressure (NPPV) and the other was the control group (n = 7), which did not require airway management. Esophageal pressure measurements were obtained in all patients, and the OA group exhibited a substantial negative esophageal pressure as compared to the control group (-41.48 ± 19.58 vs. -12.42 ± 5.77 mmHg, p < 0.001). Airway management in the OA group immediately improved the negative esophageal pressure and returned to a normal range (-41.48 ± 19.58 vs. -16 ± 8.1 mmHg, 0 < 0.001) along with a recovery from desaturation.

Conclusions: Esophageal pressure monitoring was a simple and effective method for the evaluation and management of obstructive apnea during AF catheter ablation.

Keywords: Airway management; Atrial fibrillation; Catheter ablation; Esophageal pressure.

Fig. 1

Esophageal pressure monitoring system combined with the esophageal temperature probe. An esophageal pressure line was connected to a pressure transducer.

Fig. 2

A: Esophageal pressure curve without obstructive apnea. There are periodical changes in the esophageal pressure associated with the respiratory cycle. The nadir of the esophageal pressure was approximately −10 to −15 mmHg. B: Esophageal pressure curve during obstructive apnea. A substantial deep negative esophageal pressure was recorded, and the nadir of the esophageal pressure was −50 mmHg.

Fig. 3

A: Time course of the effect of the nasal airway during the obstructive apnea. The nasal airway insertion immediately improved the substantial negative esophageal pressure. B: The effect of the airway management on the esophageal pressure and oxygen saturation in the obstructive apnea group. Pre: Before the airway management, Post: After the airway management.