Premature termination of radiofrequency delivery during pulmonary vein isolation due to oesophageal temperature alerts: impact on acute and chronic pulmonary vein reconnection

Leo, Milena; Pedersen, Michala; Rajappan, Kim; Ginks, Matthew; Bashir, Yaver; Betts, Timothy R.

doi:10.1093/europace/euw102

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…As described, neither esophagus localization nor esophagus temperature influenced recurrence rates. These findings were in line with a previous study, where increase of temperature during catheter ablation was not associated with worse rhythm outcomes …”

Section: Discussionsupporting

confidence: 93%

“…These findings were in line with a previous study, where increase of temperature during catheter ablation was not associated with worse rhythm outcomes. 22 Regarding the other risk factors for recurrences, we identified female sex and persistent AF as significant parameters for the increased recurrence rate (Table 4). This fitted the data from previous studies.…”

Section: Discussionmentioning

confidence: 93%

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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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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 93%

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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“…The findings regarding the impact of these preventive measures on the outcome of the procedure are contradictory. Although some studies report that preventive premature termination of RF energy during PVI does not affect adversely the long-term outcome of the procedure [69,70], other studies report an association of segments with PV reconnections in patients undergoing redo procedures and elevated oesophageal temperature during the index procedure [71]. It is important to know that the risk of atrial-oesophageal fistula still exists and that the above-mentioned preventive actions have limitations because the measured temperature does not necessarily reflect the true maximal temperature of the oesophagus [72], and more importantly, several cases have been reported to occur despite oesophageal temperature monitoring [66].…”

Section: Safety Of Af Ablationmentioning

confidence: 99%

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Hindricks¹,

Shamloo²,

Lenarczyk³

et al. 2018

Kardiol Pol

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Atrial fibrillation (AF) is the most common human arrhythmia. Interventional treatment with catheter ablation is an established technique that is increasingly applied and has become one of the main treatment modalities in patients with AF. Ablation results in significant improvement of symptoms and the quality of life. There is as yet no clear evidence of any impact of the procedure on hard clinical endpoints, except in patients with heart failure, who seem to benefit significantly from ablation. The cornerstone of the procedure is the achievement of pulmonary vein isolation. Radiofrequency energy is the main applied energy source, but cryoballoon ablation has emerged as a safe and effective alternative to radiofrequency ablation. Additional ablation strategies and novel technical features have been proposed but without unequivocal proof of clinical benefit. The most promising of these seems to be substrate mapping of the left atrium with substrate modification in areas with low voltage as an adjunct to pulmonary vein isolation. Complication rates remain considerable despite accumulated experience and can be partly reduced by application of preventive measures.

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Atrial mapping during pulmonary vein pacing to detect conduction gaps in a second pulmonary vein isolation procedure

Barrio-López

Castellanos

Ortiz

et al. 2018

J Interv Card Electrophysiol

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Premature termination of radiofrequency delivery during pulmonary vein isolation due to oesophageal temperature alerts: impact on acute and chronic pulmonary vein reconnection

Abstract: Just over half of patients undergoing PV isolation will have an oesophageal temperature alert, however, precautionary oesophageal temperature monitoring does not compromise ablation efficacy.

Cited by 6 publications

References 26 publications

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

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

Catheter ablation of atrial fibrillation: current status, techniques, outcomes and challengesCatheter ablation of atrial fibrillation: current status, techniques, outcomes, and challenges

Atrial mapping during pulmonary vein pacing to detect conduction gaps in a second pulmonary vein isolation procedure

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