Background: Radiofrequency ablation is a common treatment for cardiac arrythmias. Al- though a generally safe procedure, it is not exempt from complications. In particular, during pulmonary vein isolation or when the ablation is performed on the left atrial posterior wall, a non-negligible risk for hyperthermic exposure of proximal tissues, most notably the esophagus and adjacent connective tissue, exists. In the worst case scenario, it can lead to the formation of an atrioesophageal fistula, a complication that affects about one in 2500 patients, and whose associated mortality rate is above 80%.
Methods: We developed here a three-state cell death model to estimate the risk of dam- age to the esophagus during radiofrequency ablation to prevent the formation of atrial-esophageal fistula in the recovery period. An established cell death model for cardiac cells [1] was extended to capture the regenerative capabilities of esophageal tissue, by introducing a tissue condition dependent regeneration term.
Results: We validate the esophageal damage model against available experimental data at a cellular level. Following that, we apply the model on a virtual patient geometry reconstructed from a CT scan, to assess the esophageal thermal damage using a high-power RFA protocol of 90W. Some esophageal damage is observed, which is transient and recovers within the turnover period of the esophageal cells.
Discussion: Our study presents a novel model for the estimation of esophageal cell thermal damage that accounts for cellular turnover. This model can complement existing computational frameworks for ablation simulations to estimate the esophageal damage, effectively improving their predictive capability, and enhancing treatment planning and safety.
References
[1] Petras, A., Leoni, M., Guerra, J.M. and Gerardo-Giorda, L., 2023. Calibration of a three-state cell death model for cardiomyocytes and its application in radiofrequency ablation. Physiological Measurement, 44(6), p.065003.