Luminal Esophageal Temperature Monitoring With a Deflectable Esophageal Temperature Probe and Intracardiac Echocardiography May Reduce Esophageal Injury During Atrial Fibrillation Ablation Procedures: Results of a Pilot Study

May 05, 2011
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Authors:
Leite LR, Santos SN, Maia H, et al.
Citation:
Circ Arrhythm Electrophysiol 2011;4:149-156.
Summary By:
Fred Morady, MD, FACC

Study Questions:

Does repeated repositioning of an esophageal temperature probe (ETP) guided by intracardiac echocardiography (ICE) reduce the risk of esophageal injury during radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF)?

Methods:

A deflectable, 5-mm-tip ablation catheter with a thermistor embedded in its tip was inserted into the esophagus in 45 patients (mean age 55 years) undergoing RFCA of AF (paroxysmal in 47%). A phased-array ICE catheter was used to position the ETP as close as possible to the 3.5-mm, open-irrigated-tip ablation catheter. When ablating along the posterior wall, power was limited to 25 W for 30 seconds. Energy applications were aborted if the luminal esophageal temperature (LET) rose by >2ºC. Antral pulmonary vein isolation was performed in all patients, with additional left atrial ablation at the discretion of the operator. All patients underwent esophageal endoscopy 1-2 days post-ablation and received a proton-pump inhibitor for 1 week.

Results:

The LET rose by >2ºC at least once in all patients. A >2ºC rise in LET was significantly more common with right antral ablation (23/26 patients) than with left antral ablation (2/40 patients). Endoscopy did not demonstrate any esophageal injury in any patient.

Conclusions:

The risk of esophageal injury during RFCA of AF is minimized by LET monitoring with a deflectable ETP that is positioned as close as possible to the ablation catheter under ICE guidance.

Perspective:

Other studies have shown that esophageal injury is very uncommon when power is limited to 25 W on the posterior wall. Therefore, the incremental value of LET monitoring is uncertain from this observational study.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound

Keywords: Carbamates, Temperature, Esophageal Diseases, Pulmonary Veins, Catheter Ablation, Echocardiography


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