Esophageal Temperature Change and Esophageal Thermal Lesions After Pulmonary Vein Isolation Using the Novel Endoscopic Ablation System

Study Questions:

What is the risk of esophageal injury during pulmonary vein isolation (PVI) by laser ablation compared to radiofrequency catheter ablation (RFCA)?

Methods:

Sixty patients (mean age 59 years) with paroxysmal atrial fibrillation were assigned to undergo PVI using a laser balloon endoscopic catheter (n = 40) or an irrigated-tip RF ablation catheter (n = 20). With both catheters, individual lesions were created circumferentially until PVI was achieved. A temperature probe was placed in the esophagus and energy applications were discontinued whenever the esophageal temperature (ET) was ≥38.5ºC. All patients underwent endoscopy 2 days post-ablation and were treated with a proton pump inhibitor for 6 weeks.

Results:

PVI was successfully achieved in all patients in both groups. Ablation on the posterior left atrial wall resulted in an ET ≥38.5ºC in 70% of patients in the laser group and 90% of patients in the RFCA group. Endoscopy demonstrated minimal thermal lesions in 8% of patients in the laser group and 15% of patients in the RFCA group. Esophageal ulcerations were present in 10% of patients in the laser group and were not found in any of the RFCA patients. There was not a significant correlation between thermal lesions and the maximal ET in either group. No patient developed an atrioesophageal fistula.

Conclusions:

The authors concluded that risk of esophageal ulcerations is higher with laser ablation than RFCA in patients undergoing PVI.

Perspective:

The higher risk of esophageal injury with laser ablation is consistent with the deeper tissue penetration of laser energy than RF energy. Importantly, the ET data in the study confirm the limited value of luminal temperature monitoring for avoiding esophageal injury.

Clinical Topics: Arrhythmias and Clinical EP, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Temperature, Heart Atria, Esophageal Diseases, Pulmonary Veins, Endoscopy, Catheter Ablation, Fistula, Laser Therapy


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