Abstract 17281: Esophageal Re-Warming Profile During Cryoballoon Ablation Why We Should Avoid the Freeze Thaw Refreeze Technique

Abstract

Introduction: Cryoballoon ablation collateral injury such as atrial-esophageal fistula (AEF) has been reported. Dosing regimens such as the Freeze-thaw-refreeze technique are often used; however, the effect on esophageal rewarming profile is not well understood. The goal of this study is to obtain objective evidence supporting the monitoring of esophageal temperature and the avoidance of the freeze-thaw-freeze technique to reduce injury. Methods: Thirty patients undergoing cryoballoon ablation had their esophageal temperatures measured throughout the procedure using the Circa S-CathTM. Patients underwent ablation with the 28mm Arctic Front Advance® cryoballoon with dosing times of < 180 seconds. No consecutive ablations were performed. Temperature profiles using the readings from the 12 serial sensors were analyzed. Nadir temperature points were used for analysis of esophageal temperature recovery characteristic. Temperature difference intra-pole and esophageal rewarming time was recorded and compared. Results: Successful recording of esophageal temperature was seen in all patients. The average rewarming time on the lowest detected temperature to 35 C recorded. Potential false negative esophageal temperature comparing nadir pole to the neighboring temperature pole was significant (difference in over 10 degrees Celsius) in all recordings. Typical free-thaw-refreeze timing of cryoballoon (1 minute post ablation), would therefore initiate freezing when esophageal temperature are still unrecovered in all of the patients with reduced esophageal temperature. Conclusions: Esophageal temperature rewarming characteristic during cryoballoon is not well understood. Further studies are needed to more accurately assess true esophageal temperature, cooling, as well as rewarming characteristics. Consecutive cryoballoon ablation with free-thaw-refreeze technique, prior to complete esophageal rewarming, will likely result in significant esophageal injury.