Limiting esophageal temperature in radiofrequency ablation of left atrial tachyarrhythmias results in low incidence of thermal esophageal lesions.
BACKGROUND
Atrio-esophageal fistula formation following radiofrequency ablation of left atrial tachyarrhythmias is a rare but devastating complication. Esophageal injuries are believed to be precursors of fistula formation and reported to occur in up to 47% of patients. This study investigates the incidence of esophageal lesions when real time esophageal temperature monitoring and temperature limitation is used.


METHODS
184 consecutive patients underwent open irrigated radiofrequency ablation of left atrial tachyarrhythmias. An esophageal temperature probe consisting of three independent thermocouples was used for temperature monitoring. A temperature limit of 40°C was defined to interrupt energy delivery. All patients underwent esophageal endoscopy the next day.


RESULTS
Endoscopy revealed ulcer formation in 3/184 patients (1.6%). No patient developed atrio-esophageal fistula. Patient and disease characteristics had no influence on ulcer formation. The temperature threshold of 40°C was reached in 157/184 patients. A temperature overshoot after cessation of energy delivery was observed frequently. The mean maximal temperature was 40.8°C. Using a multiple regression analysis creating a box lesion that implies superior- and inferior lines at the posterior wall connecting the right and left encircling was an independent predictor of temperature. Six month follow-up showed an overall success rate of 78% documented as sinus rhythm in seven-day holter ECG.


CONCLUSIONS
Limitation of esophageal temperature to 40°C is associated with the lowest incidence of esophageal lesion formation published so far. This approach may contribute to increase the safety profile of radiofrequency ablation in the left atrium.
HELIOS Klinikum Wuppertal, Department of Cardiology, Wuppertal, Germany. armin.sause@helios-kliniken.de
Armin
A
Sause
Osman
O
Tutdibi
Karsten
K
Pomsel
Wilfried
W
Dinh
Reiner
R
Füth
Mark
M
Lankisch
Thomas
T
Glosemeyer-Allhoff
Jan
J
Janssen
Micheal
M
Müller
D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D004724:Endoscopy; D004937:Esophageal Fistula / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D004947:Esophagus / Q000293:injuries / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013610:Tachycardia / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D013696:Temperature