title: Luminal esophageal temperature rise and esophageal lesion formation following remote-controlled magnetic pulmonary vein isolation.
abstract: BACKGROUND
  Remote magnetic pulmonary vein isolation (PVI) demonstrates comparable success rate to manual ablation, but thermal effects on esophageal tissue remain undefined.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the potential thermal effects on esophageal tissue during remote magnetic wide-area circumferential pulmonary vein isolation (CPVI).
  
  
  METHODS
  Twenty-five patients (23 men, age 57 ± 10 years) in the magnetic navigation system (MNS) group and 25 control subjects (15 men, age 61 ± 12 years) with drug-refractory paroxysmal or persistent atrial fibrillation underwent CPVI. A magnetic 3.5-mm irrigated-tip catheter (NaviStar ThermoCool RMT, Biosense Webster) and a nonmagnetic 3.5-mm irrigated-tip catheter (NaviStar ThermoCool, Biosense Webster) were used in the MNS and control group, respectively. A temperature probe (SensiTherm, St. Jude Medical), containing 3 thermocouples was placed in close proximity to the ablation site monitoring luminal esophageal temperature (LET). LET changes did not guide therapy. Postprocedural esophagogastroduodenoscopy (EGD) was performed in all patients.
  
  
  RESULTS
  Successful CPVI was achieved in all patients. No esophageal lesions, minimal lesions, or ulcerations were found in 16 of 25 (64%), 7 of 25 (28%), and 2 of 25 (8%) in the MNS group and in 14 of 25 (56%), 10 of 25 (40%), and 1 of 25 (4%) patients in the control group, respectively. No atrioesophageal fistula occurred. Mean maximum LET in the magnetic group was 43.7°C ± 3.7°C compared to 45.4°C ± 3.5°C in the manual control group (P = .09).
  
  
  CONCLUSIONS
  Remote magnetic PVI is associated with significant rise in LET and development of thermal esophageal lesions. In the MNS group, higher LET recordings were more likely to cause esophageal injury, whereas this association was not seen in the manual group despite a tendency toward higher mean maximum LET recordings.
authors.affiliation: Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. melkondoc@hotmail.com
authors.forename: Melanie
authors.initials: M
authors.lastname: Konstantinidou
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.forename: Julian K R
authors.initials: JK
authors.lastname: Chun
authors.forename: Buelent
authors.initials: B
authors.lastname: Koektuerk
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.forename: Roland R
authors.initials: RR
authors.lastname: Tilz
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.forename: Alexander
authors.initials: A
authors.lastname: Fuernkranz
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D018780:Body Surface Potential Mapping; D001831:Body Temperature; D002056:Burns / Q000209:etiology* / Q000473:pathology; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation; D016145:Endoscopy, Digestive System; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D005260:Female; D006801:Humans; D008280:Magnetics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D011667:Pulmonary Veins / Q000601:surgery*; D012371:Robotics