Esophageal temperature during atrial fibrillation ablation poorly predicts esophageal injury: An observational study

Ayoub, Tarek; Hajjar, Abdel Hadi El; Sidhu, Gursukhman Deep Singh; Bhatnagar, Arezu; Zhang, Yichi; Mekhael, Mario; Noujaim, Charbel; Dagher, Lilas; Pottle, Christopher; Marrouche, Nassir F.

doi:10.1016/j.hroo.2021.11.002

Cited by 11 publications

(8 citation statements)

References 38 publications

(77 reference statements)

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“…26 In another (clinical) study, LET was again a poor predictor of esophageal injury with HPSD, and there was no association between EGDdetected injury and peak LET (43.9 ± 2.9°C with vs. 42.5 ± 2.3°C without esophageal injury). 9 In this study, HPSD-ablation was associated with periesophageal edema rather than ELs, consistent with shallower lesions.…”

Section: High Power Short Durationsupporting

confidence: 70%

“…A recent meta‐analysis including 2467 patients demonstrated similar esophageal injury rates in HPSD versus MPMD ablation 26 . In another (clinical) study, LET was again a poor predictor of esophageal injury with HPSD, and there was no association between EGD‐detected injury and peak LET (43.9 ± 2.9°C with vs. 42.5 ± 2.3°C without esophageal injury) 9 …”

Section: Discussionmentioning

confidence: 98%

“…On the other hand, high-power short-duration (HPSD) ablation is thought to prevent ELs by reducing convective heating, resulting in more shallow and circumscribed ablation lesions. 7,8 However, LET monitoring has been studied mainly for ablation with moderatepower and moderate-duration (MPMD [25-30 W/25-30s]), 9 and the results of LET monitoring may be quite different with HPSD. In addition, currently used lesion assessment tools (e.g., lesions size index [LSI]) are mathematically unsuited (first notification after a timeframe of 6 s) for HPSD protocols, increasing the risk of lesions penetrating deeper than required for transmural lesions at the LAPW.…”

Section: Introductionmentioning

confidence: 99%

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Calculated parameters of luminal esophageal temperatures predict esophageal injury following conventional and high‐power short‐duration radiofrequency pulmonary vein isolation

Meininghaus

Freund

Kleemann

et al. 2022

Cardiovasc electrophysiol

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Background Luminal esophageal temperature (LET) monitoring is not associated with reduced esophageal injury following pulmonary vein isolation (PVI). Objective Detailed analysis of (the temporal and spatial gradients of) LET measurements may better predict the risk for esophageal injury. Methods Between January 2020 and December 2021, LET maxima, duration of LET rise above baseline, and area under the LET curve (AUC) were calculated offline and correlated with (endoscopy and endoscopic ultrasound detected) esophageal injury (i.e., mucosal esophageal lesions [ELs], periesophageal edema, and gastric motility disorders) following PVI using moderate‐power moderate‐duration (MPMD [25–30 W/25–30s]) and high‐power short‐duration (HPSD [50 W/13s]) radiofrequency (RF) settings. Results 63 patients (69 ± 9 years old, 32 male, 51 MPMD and 12 HPSD) were studied. The esophageal injury was frequent (40% in both groups), mucosal ELs were more common with MPMD, and edema was frequently observed following HPSD. RF‐duration, total RF‐energy at the left atrial (LA) posterior wall, and distance between LA and esophagus were not different between patients with/without esophageal injury. In contrast, to LET and LET duration above baseline, AUC was the best predictor and significantly increased in patients with esophageal injury (3422 vs. 2444 K.s). Conclusion For both ablation strategies, AUC of the LET curves best predicted esophageal injury. HPSD is associated with similar rates of esophageal injury when (mostly subclinical) periesophageal alterations (that are of unclear clinical relevance) are included. Whether integration of these calculated LET parameters is useful to prevent esophageal injury remains to be seen.

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Section: High Power Short Durationsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Calculated parameters of luminal esophageal temperatures predict esophageal injury following conventional and high‐power short‐duration radiofrequency pulmonary vein isolation

Meininghaus

Freund

Kleemann

et al. 2022

Cardiovasc electrophysiol

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“…3,4 Technical and procedural advancements have reduced PV stenosis to negligible levels and use of esophageal temperature monitoring has significantly reduced esophageal damage (as well as AE fistula), though the benefit of esophageal temperature monitoring across energy modalities remains controversial with limited supporting data. 22,23 Phrenic nerve impairment remains at an incidence of 2%-4%, 5 varying based on definition (transient, temporary, chronic, or permanent), with permanent phrenic nerve palsy thought to occur in less than 1% of patients. 5 The present study saw zero permanent phrenic nerve palsy, with all patients recovering, and a lower rate (0%) of temporary phrenic nerve impairment in the FIT extension arm.…”

Section: Safetymentioning

confidence: 99%

One‐year outcomes of pulmonary vein isolation with a novel cryoballoon: Primary results of the FROZEN AF trial

Ellenbogen,

Mittal,

Varma

et al. 2024

Cardiovasc electrophysiol

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IntroductionCryoablation therapy for pulmonary vein isolation (PVI) to treat paroxysmal atrial fibrillation (PAF) is well established. A novel 28 mm cryoballoon system designed to operate under low pressure to safely reach a lower nadir temperature and maintain constant balloon size during cooling has not been prospectively studied in a large patient population for safety and efficacy. The FROZEN AF (NCT04133168) trial was an international multicenter, open‐label, prospective, single‐arm study on the safety and performance of a novel cryoballoon system for treatment of PAF.Methods and ResultsThe study enrolled patients at 44 sites in 10 countries across North America, Europe, and Asia. Subjects were indicated for PVI treatment of PAF and had failed or were intolerant of one or more antiarrhythmic drugs. Procedural outcomes were defined based on the 2017 HRS consensus statement. Follow‐up was performed at 7 days, 3, 6, and 12 months. Data are reported as mean ± SD or median (IQR). PVI was performed with a 28 mm cryoballoon in 325 drug refractory PAF patients. Complete PVI was achieved in 95.7% of patients. In cryoablation lesions longer than 60 s, 60.1% of PV isolations required only a single cryoballoon application. Procedure related complications included: phrenic nerve palsy [temporary 4 (1.2%), persistent 0 (0.0%)], cardiac tamponade/perforation 2 (0.6%), and air embolism 1 (0.3%). Freedom from documented atrial arrhythmia recurrence at 12 months was 79.9% (AF 82.7%, AFL 96.5%, AT 98.1%), antiarrhythmic drugs (AAD) were continued or re‐initiated in 26.8% of patients after the 3‐month blanking period. Additionally, an extension arm enrolled 50 pts for treatment with 28/31 mm variable size cryoballoon. A single temporary PNP occurred in this group, which resolved before discharge. Freedom from documented recurrence at 12 months in these pts was 82.0%.ConclusionsThis novel cryoballoon may facilitate PVI to treat PAF, providing more options to address the variety of anatomies present in patients with PAF. This cryoballoon system proved to be safe and effective for treatment of patients with drug refractory or drug intolerant PAF.

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“…Concerning the procedural safety, the operators should avoid the delivery of lesions in quick succession, as this may induce esophageal overheating and injury. Esophageal thermal injury is more common in subjects undergoing HPSD RF ablation procedures, but are not related to esophageal lesions in esophagogastroduodenoscopy [ 60 , 61 , 62 ]. Even in subjects exceeding luminaλ esophageal temperatures of 39 °C, there were no esophageal perforations or atrial–esophageal fistulas after upper endoscopic evaluation [ 63 ].…”

Section: Atrial Fibrillation Catheter Ablationmentioning

confidence: 99%

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

Theofilis

Oikonomou²,

Antonopoulos³

et al. 2022

Biomedicines

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Atrial fibrillation (AF), the most common sustained arrhythmia in clinical practice, represents a major cause of morbidity and mortality, with an increasing prevalence. Pharmacologic treatment remains the cornerstone of its management through rhythm and rate control, as well as the prevention of thromboembolism with the use of oral anticoagulants. Recent progress in percutaneous interventional approaches have provided additional options in the therapeutic arsenal, however. The use of the different catheter ablation techniques can now lead to long arrhythmia-free intervals and significantly lower AF burden, thus reducing the rate of its complications. Particularly encouraging evidence is now available for patients with persistent AF or concomitant heart failure, situations in which catheter ablation could even be a first-line option. In the field of stroke prevention, targeting the left atrial appendage with percutaneous device implantation may reduce the risk of thromboembolism to lower rates than that predicted with conventional ischemic risk scores. Left atrial appendage occlusion through the approved Watchman or Amplatzer devices is a well-established, efficacious, and safe method, especially in high-ischemic and bleeding risk patients with contraindications for oral anticoagulation.

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Esophageal temperature during atrial fibrillation ablation poorly predicts esophageal injury: An observational study

Cited by 11 publications

References 38 publications

Calculated parameters of luminal esophageal temperatures predict esophageal injury following conventional and high‐power short‐duration radiofrequency pulmonary vein isolation

Calculated parameters of luminal esophageal temperatures predict esophageal injury following conventional and high‐power short‐duration radiofrequency pulmonary vein isolation

One‐year outcomes of pulmonary vein isolation with a novel cryoballoon: Primary results of the FROZEN AF trial

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

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