title: Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study.
abstract: BACKGROUND
  Luminal esophageal temperature (LET) monitoring is one strategy to minimize esophageal injury during atrial fibrillation ablation procedures. However, esophageal ulceration and fistulas have been reported despite adequate LET monitoring. The objective of this study was to assess a novel approach to LET monitoring with a deflectable LET probe on the rate of esophageal injury in patients undergoing atrial fibrillation ablation.
  
  
  RESULTS
  Forty-five consecutive patients undergoing an atrial fibrillation ablation procedure followed by esophageal endoscopy were included in this prospective observational pilot study. LET monitoring was performed with a 7F deflectable ablation catheter that was positioned as close as possible to the site of left atrial ablation using the deflectable component of the catheter guided by visualization of its position on intracardiac echocardiography. Ablation in the posterior left atrial was limited to 25 W and terminated when the LET increased 2°C from baseline. Endoscopy was performed 1 to 2 days after the procedure. All patients had at least 1 LET elevation >2°C necessitating cessation of ablation. Deflection of the LET probe was needed to accurately measure LET in 5% of patients when ablating near the left pulmonary veins, whereas deflection of the LET probe was necessary in 88% of patients when ablating near the right pulmonary veins. The average maximum increase in LET was 2.5±1.5°C. No patients had esophageal thermal injury on follow-up endoscopy.
  
  
  CONCLUSIONS
  A strategy of optimal LET probe placement using a deflectable LET probe and intracardiac echocardiography guidance, combined with cessation of radiofrequency ablation with a 2°C rise in LET, may reduce esophageal thermal injury during left atrial ablation procedures.
authors.affiliation: Instituto Brasília de Arritmia, Brasilia, Brasil.
authors.forename: Luiz R
authors.initials: LR
authors.lastname: Leite
authors.forename: Simone N
authors.initials: SN
authors.lastname: Santos
authors.forename: Henrique
authors.initials: H
authors.lastname: Maia
authors.forename: Benhur D
authors.initials: BD
authors.lastname: Henz
authors.forename: Fábio
authors.initials: F
authors.lastname: Giuseppin
authors.forename: Anderson
authors.initials: A
authors.lastname: Oliverira
authors.forename: André R
authors.initials: AR
authors.lastname: Zanatta
authors.forename: Ayrton K
authors.initials: AK
authors.lastname: Peres
authors.forename: Clarissa
authors.initials: C
authors.lastname: Novakoski
authors.forename: Jose R
authors.initials: JR
authors.lastname: Barreto
authors.forename: Fabrício
authors.initials: F
authors.lastname: Vassalo
authors.forename: Andre
authors.initials: A
authors.lastname: d'Avila
authors.forename: Sheldon M
authors.initials: SM
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D001831:Body Temperature; D002056:Burns / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation; D057785:Catheters; D016009:Chi-Square Distribution; D004867:Equipment Design; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D009864:Ontario; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014456:Ulcer / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D018084:Ultrasonography, Interventional / Q000295:instrumentation