Severity of esophageal injury predicts time to healing after radiofrequency catheter ablation for atrial fibrillation

Incidence of esophageal injury after pulmonary vein isolation in patients with a low body mass index and esophageal temperature monitoring at a 39 °C setting

“…In the current study, the mean BMI was 23 kg/m 2 . Contreras-Valdes et al reported that 22 (27%) of 82 patients with esophageal temperature increases to 439 1C were identified with esophageal injury [6]. Their ETM was similar to that employed in the current study, however, the initial power setting of 25 W and RF duration of 20-30 s differed from those used in our study.…”

“…An incidence of 0% has been reported in some studies [9], whereas others have reported an incidence of esophageal injury as high as 40% [18]. Contreras-Valdes et al reported 37.4% of patients (82 of 219) with esophageal intraluminal temperatures 439 1C [6]. Twenty-two patients (10%) were identified with esophageal injury.…”

“…The mechanism most likely leading to atrio-esophageal fistula after radiofrequency (RF) ablation is thermal esophageal injury during the ablation procedure [4,5]. The incidence of esophageal injury after RF ablation of AF has been reported to range from 5% to 50% depending on the RF power settings and ablation strategies [6][7][8]. To avoid this complication, esophageal temperature probes, inserted nasally and advanced to the level of the left atrium (LA) under fluoroscopic guidance, are used to mark the location of the esophageal lumen and permit real-time intraluminal esophageal temperature monitoring (ETM) during ablation [9][10][11].…”

Multi‐Sensor Esophageal Temperature Probe Used During Radiofrequency Ablation for Atrial Fibrillation is Associated with Increased Intraluminal Temperature Detection and Increased Risk of Esophageal Injury Compared to Single‐Sensor Probe

“…Lesions were independently classified by gastroenterology and electrophysiology physicians who were blinded to the type of ETM probe used. Esophageal lesions were classified as mild or severe lesions . Lesions were classified as severe if they exhibited evidence of mucosal ulceration or submucosal hemorrhage.…”

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

“…882,883,884,885 Unfortunately, because the esophagus is broad, the lateral position of the temperature probe or mapping electrode might not align with the ablation electrode, and the operator could receive a false impression of safety. 1398 There is general agreement among those operators who employ temperature probes that an increase in esophageal temperature should trigger interruption of RF energy delivery.…”