title: Reduced incidence of esophageal lesions by luminal esophageal temperature-guided second-generation cryoballoon ablation.
abstract: BACKGROUND
  An increased incidence of esophageal lesions (EL) after pulmonary vein isolation (PVI) using the second-generation cryoballoon (CB2) has been described. We hypothesized that luminal esophageal temperature (LET)-guided PVI reduces the incidence of EL.
  
  
  OBJECTIVE
  The aim of this study was to investigate the incidence of EL after LET-guided PVI using the CB2.
  
  
  METHODS
  Ninety-four consecutive patients underwent CB2-PVI for paroxysmal or persistent atrial fibrillation. Target freezing time was 2 × 240 seconds. LET was continuously measured by a probe with 3 thermocouples. Early freezing interruption was performed when LET reached a prespecified cutoff temperature. A group of 32 patients who underwent CB2-PVI with observational LET measurement served as the control group. Postprocedural esophagoscopy was performed in all patients.
  
  
  RESULTS
  Compared with observational LET measurement, a strategy of LET-guided CB-PVI significantly reduced the incidence of EL from 18.8% to 3.2% (P = .008). A progressive decline in the incidence of EL was observed with an increasing LET cutoff: 7.1% (2/28 patients, 12°C cutoff) and 1.5% (1/66 patients, 15°C cutoff, P = .005 vs control). Despite early freezing interruption at a single pulmonary vein in 27% (25/94) of patients, complete PVI was achieved in all patients using the 28 mm balloon. Repeat esophagoscopy confirmed healing of EL after 1 week. After a mean of 268 ± 119 days, 87% (76/87) of patients were free of recurrent atrial fibrillation or atrial tachycardia following a 90-days blanking period.
  
  
  CONCLUSIONS
  LET-guided CB2-PVI significantly reduced the incidence of thermal EL. Interrupting cryoablation at 15°C LET was associated with the lowest incidence of esophageal injury.
authors.affiliation: Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III. Electronic address: a.fuernkranz@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Fürnkranz
authors.affiliation: Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bordignon
authors.affiliation: Medizinische Klinik I, Markus Krankenhaus, Frankfurt, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhmig
authors.affiliation: Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Konstantinou
authors.affiliation: Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III.
authors.forename: Daniela
authors.initials: D
authors.lastname: Dugo
authors.affiliation: Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III.
authors.forename: Laura
authors.initials: L
authors.lastname: Perrotta
authors.affiliation: Medizinische Klinik I, Markus Krankenhaus, Frankfurt, Germany.
authors.forename: Tom
authors.initials: T
authors.lastname: Klopffleisch
authors.affiliation: Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III.
authors.forename: Bernd
authors.initials: B
authors.lastname: Nowak
authors.affiliation: Medizinische Klinik I, Markus Krankenhaus, Frankfurt, Germany.
authors.forename: Axel U
authors.initials: AU
authors.lastname: Dignaß
authors.affiliation: Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III.
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III.
authors.forename: Julian K R
authors.initials: JK
authors.lastname: Chun
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D001831:Body Temperature / Q000502:physiology*; D003080:Cold Temperature / Q000009:adverse effects; D003452:Cryosurgery / Q000379:methods*; D004562:Electrocardiography; D004935:Esophageal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D004945:Esophagoscopy; D004947:Esophagus / Q000293:injuries / Q000503:physiopathology*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology / Q000601:surgery*
keywords: Ablation; Atrial fibrillation; Complication; Cryoballoon; Esophageal injury