Real-time monitoring of luminal esophageal temperature during left atrial radiofrequency catheter ablation for atrial fibrillation: observations about esophageal heating during ablation at the pulmonary vein ostia and posterior left atrium.
BACKGROUND
Left atrial radiofrequency catheter ablation (RFA) is gaining acceptance as treatment for drug-refractory atrial fibrillation (AF). This therapy has been associated with esophageal injury and atrioesophageal fistula formation causing death.


METHODS
We describe 3 patients undergoing catheter ablation for AF during real-time monitoring of luminal esophageal temperature.


RESULTS
We observed heating of the esophagus during short duration low power RFA, at either the left or right pulmonary vein ostia. Cryoablation at the pulmonary vein ostium in one patient resulted in esophageal cooling. Furthermore, we observed that fluoroscopic localization of the ablation catheter at a site apparently distant from the esophagus is not adequate to assure avoidance of ablation-induced esophageal heating.


CONCLUSIONS
Real-time monitoring of luminal esophageal position and temperature is feasible, enhances recognition of esophageal heating, and may add useful information beyond that provided by fluoroscopic assessment of esophageal position. There is a potential role for esophageal monitoring to help avoid thermal injury to the esophagus during catheter ablation for atrial fibrillation.
Section of Cardiac Electrophysiology, Duke University Medical Center, Durham, North Carolina, USA.
Christian
C
Perzanowski
Liane
L
Teplitsky
Patrick M
PM
Hranitzky
Tristram D
TD
Bahnson
D001281:Atrial Fibrillation / Q000601:surgery*; D001831:Body Temperature / Q000502:physiology*; D017115:Catheter Ablation / Q000009:adverse effects*; D003452:Cryosurgery; D004947:Esophagus / Q000293:injuries / Q000502:physiology*; D006325:Heart Atria; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011667:Pulmonary Veins