Oesophageal temperature monitoring and incidence of oesophageal lesions after pulmonary vein isolation using a remote robotic navigation system.
OBJECTIVE
Oesophageal lesions (EL), a potential complication after pulmonary vein isolation (PVI), have been described recently. A new remote robotic navigation system (RNS; Hansen Medical) provides enhanced catheter stability along with more effective lesion placement. The aim of this prospective study was to evaluate temperature monitoring and incidence of EL when using RNS with an irrigated tip radiofrequency catheter for PVI.


RESULTS
Circumferential PVI using RNS was performed in 73 patients (pts) with paroxysmal (n = 46, 63%) and persistent atrial fibrillation. An oesophageal temperature probe was placed in 58 (79.5%) pts and was integrated in the 3D-map (NavX). Power was limited to 25 W at the posterior wall, and in the case of an increase in temperature power was limited to 20 W. Endoscopy was performed in 42 pts within 24 h after PVI. In 44 of 58 (75.9%) pts, a significant rise in temperature (>39 degrees C) was observed. In 6 of 42 (14.3%) pts, an EL was found during endoscopy. In patients with EL, the body mass index (BMI) was significantly lower than in pts without EL (24.1 +/- 2.0 vs. 29.0 +/- 5.8, P = 0.047). The BMI of all patients with EL was <26, whereas all patients without EL had a BMI above 26. The EL showed brisk healing after re-endoscopy within 2 weeks in all pts.


CONCLUSIONS
In patients undergoing PVI using the RNS, the incidence of EL is 14.3% when using power settings comparable to settings used in manual ablation. Patients with lower BMI (<26) are at higher risk for EL.
Department of Cardiology, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Academic Hospital of the University of Freiburg, Villingen-Schwenningen 78050, Germany. arillig5@yahoo.de
Andreas
A
Rillig
Udo
U
Meyerfeldt
Ralf
R
Birkemeyer
Stefan
S
Wiest
Bernd M
BM
Sauer
Martin
M
Staritz
Werner
W
Jung
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D015992:Body Mass Index; D001831:Body Temperature / Q000502:physiology*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D004724:Endoscopy; D004947:Esophagus / Q000293:injuries* / Q000502:physiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics / Q000379:methods*