title: Increased incidence of esophageal thermal lesions using the second-generation 28-mm cryoballoon.
abstract: BACKGROUND
  Pulmonary vein isolation is an established treatment option for atrial fibrillation. To date, the incidence and quality of ablation-induced esophageal thermal lesions (ETLs) using the recently introduced second-generation cryoballoon (CB, ArcticFront Advance, Medtronic) is unknown.
  
  
  RESULTS
  In patients with drug-refractory paroxysmal atrial fibrillation or short-standing persistent atrial fibrillation, pulmonary vein (PV) isolation was performed using the second-generation CB. The endoluminal esophageal temperature was monitored via a temperature probe. After PV isolation, esophagogastroduodenoscopy (EGD) was performed to assess the incidence of ETLs. In 50 patients (18 women; age, 61±11 years; left atrial diameter, 43±5 mm), successful CB-based PV isolation was performed. Lowest median balloon temperature and esophageal temperature for the right superior PV were -51°C and 35.8°C, -47°C and 35°C for the right inferior PV, -51°C and 34.4°C for the left superior PV, -48°C and 34.6°C for the left inferior PV, and -54°C and 34.5°C for the left common PV, respectively. EGD performed 2±1 days post ablation demonstrated superficial thermal lesions and thermal ulcerations in 1 of 50 (2%) and 5 of 50 (10%) patients, respectively. In patients with ETLs, during ≥1 freeze cycle the endoluminal esophageal temperature measured <3.0°C. All thermal lesions were in the healing process on repeat EGD 4±2 days after initial endoscopy.
  
  
  CONCLUSIONS
  Using the second-generation 28-mm CB, ETLs were detected in 6 of 50 (12%) patients. All ETLs were in the healing process on repeat EGD. An esophageal temperature safety cutoff may prove valuable in the prevention of ETLs and requires further evaluation.
authors.affiliation: Departments of Cardiology and Internal Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.forename: Andre
authors.initials: A
authors.lastname: Burchard
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlmuth
authors.forename: Peter
authors.initials: P
authors.lastname: Rausch
authors.forename: Alexander
authors.initials: A
authors.lastname: Bardyszewski
authors.forename: Christina
authors.initials: C
authors.lastname: Gienapp
authors.forename: Roland Richard
authors.initials: RR
authors.lastname: Tilz
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.forename: Shibu
authors.initials: S
authors.lastname: Mathew
authors.forename: Sebastian
authors.initials: S
authors.lastname: Deiss
authors.forename: Hisaki
authors.initials: H
authors.lastname: Makimoto
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000295:instrumentation*; D003452:Cryosurgery / Q000009:adverse effects* / Q000295:instrumentation*; D016145:Endoscopy, Digestive System; D004867:Equipment Design; D004947:Esophagus / Q000293:injuries* / Q000473:pathology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000473:pathology
keywords: ablation; atrial fibrillation; complications