Abstract 17786: Presence of an Esophageal Temperature Probe During Pulmonary Vein Isolation: Is There an Increased Risk for Esophageal Lesion Development?

Abstract

Background: Luminal esophageal temperature (LET) measurement is investigated as a tool to decrease risk of esophageal lesion formation during pulmonary vein isolation using radiofrequency (RF) current. However, recent evidence from duty-cycled phased RF ablation revealed a possible contributing role of the esophageal probe to lesion formation by direct tissue heating or interaction with the ablation device. Whether the presence of a LET probe may increase lesion formation during conventional irrigated RF ablation has not yet been investigated. Methods and Results: 62 patients (65% male, age 63±11 years, LA 44±10 mm) with drug-resistant atrial fibrillation underwent circumferential pulmonary vein isolation (PVI) using irrigated RF energy and a 3D-mapping system. A maximum power of 30 Watts was applied at the left atrial posterior wall (LAPW). In 30 patients a LET probe with 5 metal electrodes (3 thermistors) was placed in the esophagus and continuously adjusted to the level of the target pulmonary vein (group 1). LET measurement was observational only and no temperature cutoff was used. In the remaining 32 patients, no LET probe was placed (group 2). All patients underwent gastro-esophagoscopy 2±1 days after the procedure. The cumulative RF energy applied to the LAPW was 21368±9449 Joules (group 1) and 18092±8143 Joules (group 2, p=0,15). Esophageal lesions were found in 12 patients (40%) of group 1 (ulcerations: 4, erythema: 8), and 11 patients (34%) of group 2 (ulcerations: 5, erythema: 4); p=0,65. Lesions healed without clinical sequelae on proton pump inhibitor therapy in all patients. Within group 1, maximum LET in patients with and without lesions was 45,7±3,7 °C and 43,8±3,9 °C, respectively (p=0,20). Conclusion: The incidence of reversible esophageal lesions after circumferential PVI using irrigated RF energy was similar whether or not a temperature probe was present in the esophagus when no temperature cutoff was used.