title: Esophageal temperature change and esophageal thermal lesions after pulmonary vein isolation using the novel endoscopic ablation system.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) is an established treatment option for paroxysmal atrial fibrillation. Recently, a novel endoscopic ablation system (EAS) was introduced. The incidence and severity of ablation-induced esophageal thermal lesions (ETLs) are unknown.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the incidence and severity of ablation-induced ETLs.
  
  
  METHODS
  This prospective analysis compared two groups: group A underwent EAS-based PVI, and group B received PVI using radio frequency current (RFC). If esophageal temperature measured via an endoluminal temperature probe exceeded 38.5°C, energy application was stopped immediately. Endoscopy was performed 2 days postablation.
  
  
  RESULTS
  Forty patients (20 female, mean age 56 ± 10 years) were treated with the EAS system (group A). In 20 patients (seven female, mean age 63 ± 9 years) RFC-based PVI was performed (group B). Esophageal endoscopy was performed 2.1 ± 0.8 (group A) and 2.8 ± 1.2 days postablation (group B), respectively. In 7/40 patients (18%) in group A, thermal lesions (four thermal ulcerations, three minimal thermal lesions) were detected. In group B, 3/20 patients (15%) displayed thermal lesions (three minimal thermal lesions). All thermal lesions resolved upon repeat endoscopy performed 8 ± 6 (group A) and 5 ± 1 days (group B) after initial endoscopy.
  
  
  CONCLUSIONS
  In the EAS group, ETLs were found in 18% of patients, as compared with in 15% in the RFC group. In patients with ETLs, ulcerations were found in 57% in the EAS group, as compared with 0% in the RFC group. This may indicate that the quality of thermal lesions is more severe in the EAS group. Further investigation is required.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. AndreasMetzner1@web.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.forename: Alexander
authors.initials: A
authors.lastname: Fuernkranz
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.forename: Roland Richard
authors.initials: RR
authors.lastname: Tilz
authors.forename: Ilka
authors.initials: I
authors.lastname: Koester
authors.forename: Melanie
authors.initials: M
authors.lastname: Konstantinidou
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.forename: Yazuhiro
authors.initials: Y
authors.lastname: Yoshiga
authors.forename: Shibu
authors.initials: S
authors.lastname: Mathew
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D001831:Body Temperature / Q000502:physiology*; D002058:Burns, Electric / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation; D017548:Echocardiography, Transesophageal; D020776:Endoscopes, Gastrointestinal / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012307:Risk Factors; D013614:Tachycardia, Paroxysmal / Q000000981:diagnostic imaging / Q000601:surgery