Temperature Monitoring and Temperature-driven irrigated Radiofrequency Energy Titration do not prevent thermally-induced Esophageal Lesions in Pulmonary Vein Isolation A randomized study controlled by esophagoscopy before and after catheter ablation.

Abstract

BACKGROUND\nEndoscopically detected esophageal lesions (EDEL) are common following pulmonary vein isolation (PVI) and may progress to atrio-esophageal fistula (AEF).\n\n\nOBJECTIVE\nTo study (1) the benefit of luminal esophageal temperature (LET) monitoring and (2) the impact of esophagogastroduodenoscopy (EGD) to detect EDEL and define preexisting lesions. The primary endpoint was the number of ablation-induced lesions.\n\n\nMETHODS\nPatients with atrial fibrillation were randomized to PVI with (LET[+]) and without (LET[-]) LET-monitoring . All patients underwent EGD before and after PVI. Ablation power at the left atrial (LA) posterior wall was limited to 25W in all, and titrated to a minimum of 10W guided by esophageal temperature in the LET[+] group.\n\n\nRESULTS\n86 patients (67±10 years, 57% male) were included, 44 in the LET[+] and 42 in the LET[-] group. PVI was achieved in all, additional linear LA lesions were done in 50%. Eight patients developed EDEL, six in the LET[+] and two in LET[-] group (p: n.s.). Whereas LET < 41°C did not differentiate with regard to EDEL formation, temperature overshooting ≥ 42°C was associated with a higher risk for new EDEL. Two-thirds of the patients showed incidental findings (esophagitis, gastric ulcer) on preprocedural EGD, eight esophageal lesions were preexisting. Four patients in the LET[+] group developed epistaxis following insertion of the probe.\n\n\nCONCLUSION\nMonitoring of the luminal esophageal temperature does not prevent ablation-induced esophageal lesions. Patients without temperature surveillance were not at higher risk, but temperatures ≥ 42°C were associated with increased likelihood of mucosal lesions.