title: Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes.
abstract: BACKGROUND
  Endoscopically detected esophageal lesions (EDELs) have been identified in apparently asymptomatic patients after catheter ablation of atrial fibrillation (AF). The use of esophageal probes to monitor luminal esophageal temperature (LET) during catheter ablation to protect esophageal damage is currently controversial.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the impact of the use of esophageal temperature probes during AF catheter ablation on the incidence of EDELs.
  
  
  METHODS
  Eighty consecutive patients (mean age 63.8 ± 11.36 years; 68.8% men) with symptomatic, drug-refractory paroxysmal (n = 52, 65%) or persistent AF who underwent left atrial radiofrequency catheter ablation were prospectively enrolled. Posterior wall ablation was power limited (≤25 W). In the first 40 patients, LET was monitored continuously (group A), whereas no esophageal temperature probe was used in group B (n = 40 patients). Assessment of EDEL was performed by endoscopy within 2 days after radiofrequency catheter ablation.
  
  
  RESULTS
  Overall, 13 patients (16%) developed EDELs after AF ablation. The incidence of EDELs was significantly higher in group A than group B (30% vs 2.5%, P < .01). Within group A, patients who developed EDEL had higher maximal LET during AF ablation than patients without EDEL (40.97 ± 0.92°C vs 40.14 ± 1.1°C, P = .02). Multivariable logistic regression analysis revealed the use of an esophageal temperature probe as the only independent predictor for the development of EDEL (odds ratio 16.7, P < .01).
  
  
  CONCLUSIONS
  The use of esophageal temperature probes in the setting of AF catheter ablation per se appears to be a risk factor for the development of EDEL.
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology; University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany. Electronic address: Patrick.Mueller-3@ruhr-uni-bochum.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Müller
authors.affiliation: University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
authors.forename: Johannes-Wolfgang
authors.initials: JW
authors.lastname: Dietrich
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology.
authors.forename: Philipp
authors.initials: P
authors.lastname: Halbfass
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology.
authors.forename: Aly
authors.initials: A
authors.lastname: Abouarab
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology.
authors.forename: Franziska
authors.initials: F
authors.lastname: Fochler
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology.
authors.forename: Atilla
authors.initials: A
authors.lastname: Szöllösi
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology.
authors.forename: Karin
authors.initials: K
authors.lastname: Nentwich
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology.
authors.forename: Markus
authors.initials: M
authors.lastname: Roos
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology.
authors.forename: Joachim
authors.initials: J
authors.lastname: Krug
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology.
authors.forename: Anja
authors.initials: A
authors.lastname: Schade
authors.affiliation: University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Mügge
authors.affiliation: Heart Center Bad Neustadt, Clinic for Interventional Electrophysiology; University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D015992:Body Mass Index; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D004937:Esophageal Fistula / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000293:injuries*; D005260:Female; D005858:Germany; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D062125:Thermometry / Q000009:adverse effects / Q000379:methods
keywords: Atrial fibrillation; Atrioesophageal fistula; Catheter ablation; Esophageal lesion; Esophageal temperature monitoring