Prevalence of Esophageal Ulceration After Atrial Fibrillation Ablation with the Hot Balloon Ablation Catheter: What is the Value of Esophageal Cooling?

Abstract

Little is known about luminal esophageal temperature (LET) monitoring during catheter ablation for atrial fibrillation (AF) using the radiofrequency hot balloon (RHB) technology. The aim of this study is to investigate the impact of the use of a unique esophageal cooling method during RHB ablation. In this observational study, 318 consecutive patients (231 men; mean age, 63 ± 9 years) with symptomatic, drug-refractory, paroxysmal (n = 183) or persistent (n = 135) AF underwent RHB ablation with LET monitoring followed by a postprocedural, nonsymptom-driven esophageal endoscopy within 3 days of the ablation procedure. The patients have been divided into 3 groups. The first 22 patients treated are in Group A (n = 22) and had only LET monitoring without cooling of the esophagus. In Groups B (n = 128) and C (n = 168), patients had LET monitoring with cooling of the esophagus when the LET exceeded 43 °C and 39 °C, by infusion of cooled saline mixed with Gastrographin or Iopamidol, respectively. Group A had a higher risk of esophageal ulceration among the 3 groups (P < 0.0001). Saline infusion cooling initiated when the LET exceeded 43 °C (Group B) was not as safe as saline infusion cooling initiated when the LET exceeded 39 °C (Group C), demonstrated by the Group C minimum ulceration score and LET measurements while ablating the left superior pulmonary vein (LSPV) and left inferior pulmonary vein (LIPV) (P < 0.0001). Cooling the esophagus by a mix of Iopamidol and saline infusion when the LET exceeds 39 °C during RHB ablation may decrease the incidence and severity of esophageal thermal injury.