title: Luminal esophageal temperature predicts esophageal lesions after second-generation cryoballoon pulmonary vein isolation.
abstract: BACKGROUND
  The novel second-generation cryoballoon (CB) facilitates pulmonary vein isolation (PVI) by improved surface cooling. The impact of this redesign on collateral damage is unknown.
  
  
  OBJECTIVE
  To investigate the incidence of esophageal lesions after PVI using the second-generation CB and the role of luminal esophageal temperature (LET) measurement as a predictor of lesion formation.
  
  
  METHODS
  Thirty-two consecutive patients underwent PVI using the second-generation 28 mm CB. Target application time was 2 × 240 seconds. Ninety-two percent of the PVs were isolated after 1 cryoenergy application. Complete PVI was achieved in all patients. LET with 3 thermocouples was continuously measured during cryoenergy application. Freezing was interrupted only if weakening/loss of phrenic nerve function or low LET (<5 °C) was observed.
  
  
  RESULTS
  The lowest measured LET was-12 °C (despite cryoapplication interruption). Postprocedural gastroesophagoscopy was performed after 1-3 days in all patients and showed lesions in 6 of 32 (19%) patients. A minimum LET of≤12 °C predicted esophageal lesions with 100% sensitivity and 92% specificity (area under the receiver-operator characteristic curve 0.97; 95% CI 0.93-1.02; P = .001). Persistent phrenic nerve palsy occurred in 2 (6%) patients during ablation at the right inferior pulmonary vein. Repeat gastroesophagoscopy confirmed healing of lesions after 16 ± 14 days.
  
  
  CONCLUSIONS
  Second-generation 28 mm CB PVI is associated with significant esophageal cooling, resulting in lesion formation in 19% of the patients. LET measurement accurately predicts lesion formation and may enhance the safety of the novel device.
authors: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Frankfurt, Germany.
authors: Alexander
authors: A
authors: Fürnkranz
authors: Stefano
authors: S
authors: Bordignon
authors: Boris
authors: B
authors: Schmidt
authors: Michael
authors: M
authors: Böhmig
authors: Marie-Christine
authors: MC
authors: Böhmer
authors: Frank
authors: F
authors: Bode
authors: Britta
authors: B
authors: Schulte-Hahn
authors: Bernd
authors: B
authors: Nowak
authors: Axel U
authors: AU
authors: Dignaß
authors: Julian K R
authors: JK
authors: Chun
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D001831:Body Temperature; D003452:Cryosurgery / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D004935:Esophageal Diseases / Q000175:diagnosis / Q000209:etiology*; D004945:Esophagoscopy; D005260:Female; D005471:Fluoroscopy; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery