title: Impact of esophageal temperature monitoring guided atrial fibrillation ablation on preventing asymptomatic excessive transmural injury.
abstract: BACKGROUND
  Even with the use of a reduced energy setting (20-25 W), excessive transmural injury (ETI) following catheter ablation of atrial fibrillation (AF) is reported to develop in 10% of patients. However, the incidence of ETI depends on the pulmonary vein isolation (PVI) method and its esophageal temperature monitor setting. Data comparing the incidence of ETI following AF ablation with and without esophageal temperature monitoring (ETM) are still lacking.
  
  
  METHODS
  This study was comprised of 160 patients with AF (54% paroxysmal, mean: 24.0±2.9 kg/m(2)). Eighty patients underwent ablation accompanied by ETM. The primary endpoint was defined as the occurrence of ETI assessed by endoscopy within 5 d after the AF ablation. The secondary endpoint was defined as AF recurrence after a single procedure. If the esophageal temperature probe registered >39 °C, the radiofrequency (RF) application was stopped immediately. RF applications could be performed in a point-by-point manner for a maximum of 20 s and 20 W. ETI was defined as any injury that resulted from AF ablation, including esophageal injury or periesophageal nerve injury (peri-ENI).
  
  
  RESULTS
  The incidence of esophageal injury was significantly lower in patients whose AF ablation included ETM compared with patients without ETM (0 [0%] vs. 6 [7.5%], p=0.028), but not the incidence of peri-ENI (2 [2.5%] vs. 3 [3.8%], p=1.0). AF recurrence 12 months after the procedure was similar between the groups (20 [25%] in the ETM group vs. 19 [24%] in the non-ETM group, p=1.00).
  
  
  CONCLUSIONS
  Catheter ablation using ETM may reduce the incidence of esophageal injury without increasing the incidence of AF recurrence but not the incidence of peri-ENI.
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Kiuchi
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Okajima
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shimane
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Gaku
authors.initials: G
authors.lastname: Kanda
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Kiminobu
authors.initials: K
authors.lastname: Yokoi
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Teranishi
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Kousuke
authors.initials: K
authors.lastname: Aoki
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Misato
authors.initials: M
authors.lastname: Chimura
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Toba
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Oishi
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sawada
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Yasue
authors.initials: Y
authors.lastname: Tsukishiro
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Tetsuari
authors.initials: T
authors.lastname: Onishi
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Seiichi
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Taniguchi
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Yasaka
authors.affiliation: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Kawai
authors.affiliation: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Fukuzawa
authors.affiliation: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Itoh
authors.affiliation: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Kimitake
authors.initials: K
authors.lastname: Imamura
authors.affiliation: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Ryudo
authors.initials: R
authors.lastname: Fujiwara
authors.affiliation: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Suzuki
authors.affiliation: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakanishi
authors.affiliation: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Yamashita
authors.affiliation: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
authors.affiliation: Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tada
authors.affiliation: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Hiro
authors.initials: H
authors.lastname: Yamasaki
authors.affiliation: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Naruse
authors.affiliation: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Miyako
authors.initials: M
authors.lastname: Igarashi
authors.affiliation: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Saishyo Kou 520, Himeji, Hyogo, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
keywords: Atrial fibrillation; Catheter ablation; Esophageal injury; Esophageal temperature monitoring; Periesophageal nerve injury