Esophageal luminal temperature monitoring using a multi-sensor probe lowers the risk of esophageal injury in cryo and radiofrequency catheter ablation for atrial fibrillation

Abdulsalam, Nashwa; Sridhar, Arun; Tregoning, Deanna; He, B. Julie; Jafarvand, Mahbod; Mehri, Avin; Afroze, Tanzina; Chahine, Yaacoub; Ko, Cynthia W.; Akoum, Nazem

doi:10.1007/s10840-023-01492-1

Cited by 2 publications

(5 citation statements)

References 25 publications

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“…5,21 The efficacy of LET monitoring can also vary depending on the type of probe used (multisensor probe vs. singlesensor probe). Multisensor probes are more sensitive to the detection of LET changes, and were recently suggested to decrease the incidence of EDEL compared to single transducer probes, 13 by virtue of covering a wider area and having a higher sampling rate for temperature change. 22,23 There currently is no consensus in the ablation community on the temperature limits beyond which ablation lesion delivery should be discontinued.…”

Section: Discussionmentioning

confidence: 99%

“…The mean highest temperature in our study was 40.1°C and the median was 40.3°C which falls in line with reports from Knecht et al 11 and Di Biase et al 12 which mention overshooting of 1.6–1.8°C. Areas with a demonstrated rise in temperature that still required ablation were treated with shorter lesions durations first, followed by reduced power to 30 W if further ablation was still needed 13 . If significant LET rise was still observed with these measures, then the ablation lines were adjusted to avoid ablating in the area of temperature rise.…”

Section: Methodsmentioning

confidence: 99%

“…In case of failure to achieve isolation due to the limitation of cold balloon or esophageal luminal temperature, targeted RFA lesions were delivered, and temperature monitoring was used in a similar fashion to the RFA approach described above 14 . Our criteria for discontinuing ablation were similar to previous studies 13–15 …”

Section: Methodsmentioning

confidence: 99%

“…Areas with a demonstrated rise in temperature that still required ablation were treated with shorter lesions durations first, followed by reduced power to 30 W if further ablation was still needed. 13 If significant LET rise was still observed with these measures, then the ablation lines were adjusted to avoid ablating in the area of temperature rise.…”

Section: Esophageal Luminal Temperature Monitoringmentioning

confidence: 99%

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Machine learning identifies esophageal luminal temperature patterns associated with thermal injury in catheter ablation for atrial fibrillation

Chahine,

Afroze,

Bifulco

et al. 2024

Cardiovasc electrophysiol

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IntroductionLuminal esophageal temperature (LET) monitoring during atrial fibrillation (AF) ablation is widely used to reduce the incidence of endoscopically detected esophageal lesion (EDEL). We sought to assess whether specific patterns of LET variation are associated with EDEL.MethodsA high‐fidelity multisensor probe was used to record LET in AF patients undergoing radiofrequency ablation (RFA) or cryoballoon ablation (CBA). Explainable machine learning and SHapley Additive exPlanations (SHAP) analysis were used to predict EDEL and assess feature importance.ResultsA total of 94 patients (38.3% persistent AF, 71.3% male, 72 RFA, and 22 CBA) were included. EDEL was detected in 11 patients (10 RFA and one CBA). In the RFA group, the highest LET recorded was similar between patients with and without EDEL (40.6 [40.1–41]°C vs. 40.2 [39.1–40.9]°C; p = .313), however, the rate of LET rise for the highest recorded peak was higher (0.08 [0.03–0.12]°C/s vs. 0.02 [0.01–0.05]°C/s; p = .033), and the area under the curve (AUC) for the highest peak was smaller (412.5 [206.8–634.1] vs. 588.6 [380.4–861.1]; p = .047) in patients who had EDEL. In case of CBA, the patient with EDEL had a faster LET decline (0.12 vs. 0.07 [0.02–0.14]°C/s), and a smaller AUC for the lowest trough (2491.3 vs. 2629.3 [1712.6–5283.2]). SHAP analysis revealed that a rate of LET change higher than 0.05°C/s and an AUC less than 600 were more predictive of EDEL in RFA.ConclusionThe rate of LET change and AUC for the recorded temperature predicted EDEL, whereas absolute peak temperatures did not.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Esophageal Luminal Temperature Monitoringmentioning

confidence: 99%

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Machine learning identifies esophageal luminal temperature patterns associated with thermal injury in catheter ablation for atrial fibrillation

Chahine,

Afroze,

Bifulco

et al. 2024

Cardiovasc electrophysiol

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“…This monitoring use is a general agreement that has been recommended by the 2017 AF ablation consensus (29). To add, the use of multi-sensor instead of single sensor probe is associated with lower incidence of esophageal lesions (30). However, the use of esophageal temperature monitoring probe is not the sole way to prevent ETI, as energy delivery and contact force control should be taken into account during ablation.…”

Section: Discussionmentioning

confidence: 99%

High Power Short Duration vs Low Power Long Duration Catheter Ablation of Atrial Fibrillation

Rheinhardo Lolonlun,

Christian Fernandez

2024

JARMHS

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Backgrounds : Atrial Fibrillation (AF) is a known common arrythmia, affecting around 33 million people worldwide. Catheter ablation is a safe and effective treatment for paroxysmal and persistent AF that are unresponsive to drug treatment. However, long procedural duration of AF ablation has raised the concern of radiation hazard and post-procedural complications. The high power short duration (HPSD) technique is an emerging method that has been introduced as an alternative to reduce procedural time of AF ablation. Objective: This study attempts to review the safety and efficacy of HSPD compared to the conventional low power long duration (LPLD) ablation in AF patients. Method : A search through PubMed, Science Direct, JSTORE, and clinicaltrial.gov was conducted. The keywords used were (catheter ablation OR radiofrequency OR pulmonary vein isolation) AND (atrial fibrillation) AND (high power short duration OR 50 W). The search was limited from 2006 to 2024. Risk of bias assessment was conducted through Newcastle-Ottawa Scale (NOS) assessment. Results: Among 55,802 journals reviewed, we retrieved 10 journals that met the inclusion criteria. This study found that HPSD ablation results in either better or comparable efficacy in maintaining long term sinus rhythm post ablation. Additionally, there was no difference in safety for both HPSD and LPLD. We also recommend using esophageal temperature monitoring probe and adjusting energy delivery during posterior wall ablation to avoid injuring esophagus. Conclusion: Our study concluded that HPSD ablation is a safe choice of treatment for drug-refractory paroxysmal or persistent AF with a noteworthy outcome compared to LPLD ablation.

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Esophageal luminal temperature monitoring using a multi-sensor probe lowers the risk of esophageal injury in cryo and radiofrequency catheter ablation for atrial fibrillation

Cited by 2 publications

References 25 publications

Machine learning identifies esophageal luminal temperature patterns associated with thermal injury in catheter ablation for atrial fibrillation

Machine learning identifies esophageal luminal temperature patterns associated with thermal injury in catheter ablation for atrial fibrillation

High Power Short Duration vs Low Power Long Duration Catheter Ablation of Atrial Fibrillation

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