title: Esophagus-Related Complications During Second-Generation Cryoballoon Ablation-Insight from Simultaneous Esophageal Temperature Monitoring from 2 Esophageal Probes.
abstract: Monitoring luminal esophageal temperatures (LETs) helps predict esophageal thermal lesions (ETLs) after catheter ablation. This study aimed to evaluate esophagus-related complications after second-generation cryoballoon ablation under simultaneous LETs monitoring from 2 esophageal probes.
  
  
  
  Forty consecutive paroxysmal atrial fibrillation patients undergoing second-generation cryoballoon ablation under conscious sedation followed by esophagogastroscopy were prospectively included. Two temperature probes inserted bi-nasally (both non-deflectable in 13, non-deflectable and deflectable in 27 patients) were used for LET monitoring. Pulmonary vein isolation was performed with one 28-mm balloon using single 3-minute freeze techniques.
  
  
  
  The lowest LETs significantly correlated between different probes; however, deflectable probe showed significantly lower nadir LETs than non-deflectable probes (14.6 ± 9.2 vs. 20.0 ± 10.6 ℃, P<0.0001). Esophagogastroscopy post-ablation demonstrated ETLs and gastroparesis in 8 (20%) and 7 (17.5%) patients (total 13 [32.5%]), respectively. The optimal cutoff for the lowest LET measured on any probe for predicting no ETLs was 12.8 ℃ (sensitivity 78.1%, specificity 100%). When using deflectable and non-deflectable catheters, the optimal cutoff point for the lowest LET for predicting no ETLs was 11.4 ℃ (sensitivity 70.0%, specificity 100%) and 19.4 ℃ (sensitivity 63.6%, specificity 100%), respectively. No ETLs were detected in 12 (30%) patients with the esophagus located between the left atrium and spine. All esophagus-related complications were asymptomatic and had healed on repeat esophagogastroscopy by a mean of 53 ± 25 days after the procedure.
  
  
  
  The lowest LET highly depended on the temperature probe location. However, if a different cutoff value was applied, LET monitoring, regardless of the probe type, and anatomical information might help predict ETLs during second-generation cryoballoon ablation.
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki. mshinsuke@k3.dion.ne.jp.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Takagi
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki.
authors.forename: Jin
authors.initials: J
authors.lastname: Iwasawa
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hachiya
authors.affiliation: Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Hirao
authors.affiliation: Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Iesaka
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001831:Body Temperature; D062906:Cardiac Catheters; D003452:Cryosurgery / Q000009:adverse effects* / Q000295:instrumentation*; D004867:Equipment Design; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D013817:Thermography / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; cryoballoon; esophageal injury; gastroparesis; pulmonary vein isolation