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