Esophageal endoscopy results after pulmonary vein isolation using the single big cryoballoon technique.
BACKGROUND
Reversible esophageal thermal lesions after cryoballoon pulmonary vein isolation (CB-PVI) have been reported when using variable balloon sizes. The aim of this study was to investigate (1) the incidence of esophageal thermal lesions, and (2) esophageal temperature changes associated with CB-PVI using the single big cryoballoon technique.


RESULTS
Thirty-eight patients with atrial fibrillation underwent successful CB-PVI using only the 28 mm cryoballoon. Luminal esophageal temperature (LET) was continuously monitored by 3 thermocouples. Fluoroscopic distance from cryoballoon to esophagus probe was retrospectively evaluated in RAO 30 degrees and LAO 40 degrees projections. All patients underwent postprocedural esophageal endoscopy. Average minimal LET was lower during freezing at inferior PVs, when compared to superior PVs: 35.4 +/- 0.9 (range: 32.6 to 37.4; RSPV); 31.5 +/- 7.5 (2.5 to 37.6; RIPV); 32.9 +/- 5.2 (8.5 to 36.5; LSPV); and 30.3 +/- 8.4 degrees C (-6 to 36.7 degrees C; LIPV); P = 0.001. We found steep temperature gradients over distance (1) from the cryoballoon center (LETs < 10 degrees C confined to a distance of < 15 mm in both RAO 30 degrees and LAO 40 degrees projections), and (2) along the esophagus long axis, underscoring the need for multiple measurement sites. None of the patients showed esophageal thermal lesions at endoscopy after 3 +/- 1 (range 1-7) days. No AEF occurred during a follow-up of 125 +/- 78 days.


CONCLUSIONS
In a cohort of AF patients treated by the single big cryoballoon technique, CB-PVI was not associated with thermal esophageal lesions.
Department of Cardiology, Asklepios Klinik St. Georg, Med. Klinik, 5 Lohmühlenstrasse, Hamburg, Germany. a.fuernkranz@gmail.com
Alexander
A
Fürnkranz
K R Julian
KR
Chun
Andreas
A
Metzner
Dieter
D
Nuyens
Boris
B
Schmidt
Andre
A
Burchard
Roland
R
Tilz
Feifan
F
Ouyang
Karl Heinz
KH
Kuck
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D001831:Body Temperature; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation; D003452:Cryosurgery / Q000009:adverse effects* / Q000295:instrumentation; D004867:Equipment Design; D004937:Esophageal Fistula / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome