Impact of esophageal temperature monitoring guided atrial fibrillation ablation on preventing asymptomatic excessive transmural injury

Abstract

BackgroundEven with the use of a reduced energy setting (20–25 W), excessive transmural injury (ETI) following catheter ablation of atrial fibrillation (AF) is reported to develop in 10% of patients. However, the incidence of ETI depends on the pulmonary vein isolation (PVI) method and its esophageal temperature monitor setting. Data comparing the incidence of ETI following AF ablation with and without esophageal temperature monitoring (ETM) are still lacking.MethodsThis study was comprised of 160 patients with AF (54% paroxysmal, mean: 24.0±2.9 kg/m2). Eighty patients underwent ablation accompanied by ETM. The primary endpoint was defined as the occurrence of ETI assessed by endoscopy within 5 d after the AF ablation. The secondary endpoint was defined as AF recurrence after a single procedure. If the esophageal temperature probe registered >39 °C, the radiofrequency (RF) application was stopped immediately. RF applications could be performed in a point-by-point manner for a maximum of 20 s and 20 W. ETI was defined as any injury that resulted from AF ablation, including esophageal injury or periesophageal nerve injury (peri-ENI).ResultsThe incidence of esophageal injury was significantly lower in patients whose AF ablation included ETM compared with patients without ETM (0 [0%] vs. 6 [7.5%], p=0.028), but not the incidence of peri-ENI (2 [2.5%] vs. 3 [3.8%], p=1.0). AF recurrence 12 months after the procedure was similar between the groups (20 [25%] in the ETM group vs. 19 [24%] in the non-ETM group, p=1.00).ConclusionsCatheter ablation using ETM may reduce the incidence of esophageal injury without increasing the incidence of AF recurrence but not the incidence of peri-ENI.

The influence of ablation power reduction associated with oesophagus location on pulmonary vein isolation results in patients with paroxysmal atrial fibrillation: six-month follow-up

“…acute pyloric spasms and gastric hypomotility). The incidence of oesophageal injury after radiofrequency (RF) ablation of AF has been reported to range from 2.9% to 50% (mostly as localised erythema), depending on the RF power settings and ablation strategies [1][2][3][4][5][6][7][8][9][10][11][12][13].…”

“…To avoid these complications, real-time intraluminal oesophageal temperature monitoring during ablation with the oesophageal temperature probes advanced to the level of the LA could be used. Additionally, the probe could be a marker of the oesophageal lumen location in relation to PV ostia [3,12,[14][15][16][17]. It was reported that the use of temperature monitoring significantly reduces the oesophageal injury ratio (6% vs. 36%, p < 0.006) without any serious complications related to the probe [3,12].…”

Esophageal position, measured luminal temperatures, and risk of atrioesophageal fistula with atrial fibrillation ablation

“…Strategies to reduce esophageal injury have included the use of esophageal temperature probes to monitor esophageal heating during AF ablation. Prior work has shown a reduction in esophageal injury in cases supported by esophageal temperature monitoring though recent literature has been less conclusive . Small series have shown variability in esophageal heating during AF ablation dependent on esophageal location .…”

“…Prior work has shown a reduction in esophageal injury in cases supported by esophageal temperature monitoring though recent literature has been less conclusive. 10,11 Small series have shown variability in esophageal heating during AF ablation dependent on esophageal location. 12 Compared to patients without confinement, we found those with esophageal confinement had significantly higher peak ELT during AF ablation relative to baseline ELT derived from recordings throughout the duration of ablation.…”

Low Incidence of Esophageal Lesions After Pulmonary Vein Isolation Using Contact-Force Sensing Catheter Without Esophageal Temperature Probe

“…8,11) On the other hand, Kiuchi, et al demonstrated a benefit for using an ETP with decreased esophageal injury. 16) Keshishian, et al reported a series of three patients with mucosal erythema and shallow and deep ulceration after PVI. 17) The EDEL documented in our study resemble those lesions reported by other groups with all EDEL healed in between two weeks.…”