Esophageal Luminal Temperature Measurement Underestimates Esophageal Tissue Temperature During Radiofrequency Ablation Within the Canine Left Atrium: Comparison Between 8 mm Tip and Open Irrigation Catheters

Cummings, Jennifer E.; Barrett, Conor D.; Litwak, Kenneth N.; Biase, Luigi Di; Chowdhury, P.; Oh, Seil; Ching, Chi Keong; Saliba, Walid; Schweikert, Robert A.; Burkhardt, J. David; Marco, Shari De; Armaganijan, Luciana; Natale, Andrea

doi:10.1111/j.1540-8167.2008.01130.x

Cited by 58 publications

(37 citation statements)

References 14 publications

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“…24,25 However, luminal temperature does not necessarily reflect temperature within the esophageal wall. 26 Additionally, because parameters followed during energy delivery such as power or impedance are not predictive of temperature rises, it is difficult to predict the effects on the esophagus.…”

Section: Anatomic Considerationsmentioning

confidence: 99%

Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial Fibrillation

Biase

Sáenz

Burkhardt

et al. 2009

Circ: Arrhythmia and Electrophysiology

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201

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Background— Left atrioesophageal fistula is a rare but devastating complication that may occur after catheter ablation of atrial fibrillation. We used capsule endoscopy to assess esophageal injury after catheter ablation for atrial fibrillation in a population randomized to undergo general anesthesia or conscious sedation. Methods and Results— Fifty patients undergoing atrial fibrillation ablation for paroxysmal symptomatic atrial fibrillation refractory to antiarrhythmic drugs were enrolled and randomized, including those undergoing the procedure under general anesthesia (25 patients, group 1) and those receiving conscious sedation with fentanyl or midazolam (25 patients, group 2). All patients underwent esophageal temperature monitoring during the procedure. The day after ablation, all patients had capsule endoscopy to assess the presence of endoluminal tissue damage of the esophagus. We observed esophageal tissue damage in 12 (48%) patients of group 1 and 1 esophageal tissue damage in a single patient (4%) of group 2 ( P <0.001). The maximal esophageal temperature was significantly higher in patients undergoing general anesthesia (group 1) versus patients undergoing conscious sedation (group 2) (40.6�1�C versus 39.6�0.8�C; P < 0.003). The time to peak temperature was 9�7 seconds in group 1 and 21�9 seconds in group 2, and this difference was statistically significant ( P <0.001). No complication occurred during or after the administration of the pill cam or during the procedures. All esophageal lesions normalized at the 2-month repeat endoscopic examination. Conclusion— The use of general anesthesia increases the risk of esophageal damage detected by capsule endoscopy.

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Section: Anatomic Considerationsmentioning

confidence: 99%

Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial Fibrillation

Biase

Sáenz

Burkhardt

et al. 2009

Circ: Arrhythmia and Electrophysiology

Self Cite

201

View full text Add to dashboard Cite

show abstract

“…There are 3 major issues possibly explaining differences among reports, namely catheters used, maximum energy settings, and energy titration methods. Data on catheter dependence of EU are confusing (28,62,63,64 (65). In our study, we again demonstrate a low incidence of EU using an OIC technique, confirming previous results of a randomized prospective trial.…”

Section: Identification Of a High-risk Population For Esophageal Injusupporting

confidence: 79%

“…In our study, we again demonstrate a low incidence of EU using an OIC technique, confirming previous results of a randomized prospective trial. Temperature probes were used to monitor energy delivery and temperature increase in the esophagus in other studies (28,31,58,63,65). As stated in these studies, luminal esophageal temperature (LET) monitoring has major limitations, such as malalignment of the probe to the RFA catheter and posterior LA wall, the underestimation of intramural temperature by an intraluminal probe, and the too-slow LET increase to prevent EU.…”

Section: Identification Of a High-risk Population For Esophageal Injumentioning

confidence: 99%

New aspects of ablation treatment for atrial fibrillation

Bencsik¹

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“…Second, luminal esophageal temperature may not be representative of intramural esophageal temperature. 12 However, there are currently no clinically available methods of determining intramural esophageal temperature. Third, only the presence of esophageal mucosal injury was assessed.…”

Section: Limitationsmentioning

confidence: 99%

Luminal Esophageal Temperature Monitoring With a Deflectable Esophageal Temperature Probe and Intracardiac Echocardiography May Reduce Esophageal Injury During Atrial Fibrillation Ablation Procedures

Leite

Santos

Maia

et al. 2011

Circ: Arrhythmia and Electrophysiology

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Background-Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation. Methods and Results-Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation Ͼ2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5Ϯ1.5°C. No patients had esophageal thermal injury on follow-up endoscopy. Conclusions-A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures. (Circ Arrhythm Electrophysiol. 2011;4:149-156.)

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Esophageal Luminal Temperature Measurement Underestimates Esophageal Tissue Temperature During Radiofrequency Ablation Within the Canine Left Atrium: Comparison Between 8 mm Tip and Open Irrigation Catheters

Abstract: Despite the significant difference in actual tissue temperatures, no significant difference was observed in luminal temperatures between the OIC and 8 mm tip catheter.

Cited by 58 publications

References 14 publications

Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial Fibrillation

Esophageal Capsule Endoscopy After Radiofrequency Catheter Ablation for Atrial Fibrillation

New aspects of ablation treatment for atrial fibrillation

Luminal Esophageal Temperature Monitoring With a Deflectable Esophageal Temperature Probe and Intracardiac Echocardiography May Reduce Esophageal Injury During Atrial Fibrillation Ablation Procedures

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