Comparison between single- and multi-sensor oesophageal temperature probes during atrial fibrillation ablation: thermodynamic characteristics

Tschabrunn, Cory M.; Silverstein, Joshua R.; Berzin, Tyler M.; Ellis, Ethan R.; Buxton, Alfred E.; Josephson, Mark E.; Anter, Elad

doi:10.1093/europace/euu356

Cited by 51 publications

(32 citation statements)

References 22 publications

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“…In order to overcome these two limitations, another esophageal thermometer has been developed, in which multiple electrodes are distributed along the catheter in a sinusoidal format to occupy the flat surface of the esophagus. 20 The clinical use of this second system has shown higher sensitivity and readiness to detect increases in esophageal temperature. However, there are no randomized studies comparing the efficacy of both systems or the ability of this device in maintaining the esophagus distended, moving it closer to the LA.…”

mentioning

confidence: 99%

Current Atrial Fibrillation Ablation: An Alert for the Prevention and Treatment of Esophageal Lesions

Scanavacca¹

2016

Arquivos Brasileiros De Cardiologia

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mentioning

confidence: 99%

Current Atrial Fibrillation Ablation: An Alert for the Prevention and Treatment of Esophageal Lesions

Scanavacca¹

2016

Arquivos Brasileiros De Cardiologia

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“…17 Different other strategies have been evaluated to reduce the risk of thermal injury during AF ablations. For example, multisensor expandable probes, 18 ablation catheter with increased irrigation channels 19 and mechanical displacement of esophagus 20 Another important finding was the independence of recurrence rates of AF after ablation from the esophageal position or temperature.…”

Section: Discussionmentioning

confidence: 99%

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

Stauber

Kornej

Bollmann

et al. 2020

Pacing Clinical Electrophis

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Background Thermolesions are a dangerous complication of atrial fibrillation (AF) ablation. We aimed to assess the reasons for thermolesions and the effect of esophageal position on recurrences. Methods The study included consecutive patients undergoing AF catheter ablation at Heart Center Leipzig between January and September 2014. We collected data of esophagus localization, temperature, endoscopy, and follow‐up. Results The study included 645 patients into analyses. A total of 626 (97.2%) received a temperature probe. Esophageal position was categorized: (A) behind left pulmonary veins, (B) left ostial, (C) in the middle of left atrium, (D) right ostial, and (E) behind right pulmonary veins. The most frequent esophageal position was B‐C (n = 201, 32.1%), followed by B (n = 161, 25.7%), and C (n = 147, 23.5%). The temperature was highest in A‐B positions (42.04°C) and in D‐E positions (41.70°C). There was a significant correlation between the endoscopically detected esophageal lesions (EDEL) and the esophageal position (r² = −.115, P = .004) and the esophageal temperature (r² = .162, P = .000), but not with body mass index (BMI) (r² = −.016, P = .688). Additional substrate modification in the left atrium resulted in significantly higher esophageal temperatures (P < .001) and more frequent EDEL (P = .049). An EDEL was found in 15 patients (2.3% of all patients, 5.6% of patients receiving endoscopy). Of those, the median esophageal temperature was 41.8°C (interquartile range [IQR]: 41.2‐42.4). Neither esophageal position nor temperature during ablation was associated with arrhythmia recurrences (both P > .400). Conclusions EDEL depended on the esophageal position and temperature, but not on BMI. Esophageal position and intraluminal temperature during ablation had no effect on recurrences.

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“…Early studies suggest that multisensor probes present superior temperature monitoring and may reduce esophageal injury. 23 One such device is the Circa S-Cath Temperature Monitor (Circa Scientific, Englewood, CO, USA), a flexible probe that conforms to the esophageal shape and which is insulated to reduce conductivity. 24 It features 12 temperature sensors that provide feedback continuously.…”

Section: Sedationmentioning

confidence: 99%

“…24 In a recent study, this probe was able to detect 0.2°C temperature fluctuations up to 17 seconds faster than comparable single-sensor probes (mean detection time: 13.4 seconds versus 30.5 seconds). 23,24 Infrared thermography is another new tool for esophageal temperature management, in which esophageal temperature is measured continuously by an infrared scan rather than direct conduction to a probe. 22 Daly et al…”

Section: Sedationmentioning

confidence: 99%

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Prevention and Treatment of Atrioesophageal Fistula Related to Catheter Ablation for Atrial Fibrillation

Bodziock

Norton

Montgomery

2019

J Innov Cardiac Rhythm Manage.

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Atrioesophageal fistula (AEF) is an uncommon but devastating complication of catheter ablation for atrial fibrillation. Even with appropriate recognition and treatment, mortality is greater than 30% in most studies. If AEF is suspected, it is essential to avoid endoscopy and to order immediate cross-sectional imaging. If the diagnosis is confirmed, a thoracic surgeon should be promptly notified and must assess the patient urgently. The prognosis for AEF is poor even if it is appropriately recognized and addressed, so prevention must be a high priority. Prevention of AEF should involve the use of low-risk and cost-effective measures during ablation, which may increase safety, efficacy, or both. These strategies may include conscious sedation (as opposed to general anesthesia), low-power ablation, low-flow irrigation, short-duration lesions, esophageal temperature measurement, esophageal deviation, and pharmacologic prophylaxis with proton pump inhibitors or histamine H 2 receptor blockers. Multiple new technologies are now becoming available, which may further reduce esophageal injury. Proceduralists should be aware of the available techniques and equipment that may help to reduce the risk of AEF, while simultaneously considering the possibility of unintended consequences.

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Comparison between single- and multi-sensor oesophageal temperature probes during atrial fibrillation ablation: thermodynamic characteristics

Abstract: Multi-sensor probes provide a superior thermodynamic profile. Its clinical value in reducing oesophageal injury requires further evaluation.

Cited by 51 publications

References 22 publications

Current Atrial Fibrillation Ablation: An Alert for the Prevention and Treatment of Esophageal Lesions

Current Atrial Fibrillation Ablation: An Alert for the Prevention and Treatment of Esophageal Lesions

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

Prevention and Treatment of Atrioesophageal Fistula Related to Catheter Ablation for Atrial Fibrillation

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