title: Reliability of luminal oesophageal temperature monitoring during radiofrequency ablation of atrial fibrillation: insights from probe visualization and oesophageal reconstruction using magnetic resonance imaging.
abstract: OBJECTIVE
  A current concept to prevent atrio-oesophageal fistula during radiofrequency (RF) catheter ablation of atrial fibrillation is to monitor luminal oesophageal temperature (LET). The objective of this study was to describe the temporal course of LET and to assess the reliability of monitoring the maximal LET during pulmonary vein isolation (PVI) using irrigated multi-electrode (IMEA, nMARQTM) and focal ablation catheters.
  
  
  RESULTS
  We studied 40 patients with LET monitoring during PVI (20 patients using the IMEA and 20 patients using the focal catheter). A linear probe was used and visualized in the 3D mapping system. Left atrial and oesophageal reconstructions from delayed enhanced magnetic resonance imaging were integrated. Analysing 745 temperature profiles, LET >38°C was observed in 48 of 296 (17%) and 44 of 449 (10%) ablations for the IMEA and the focal catheter, respectively (P = 0.012). Temporal latency after interruption of RF energy delivery was observed for both catheters. Time until LET baseline temperature was restored after an increase of >1°C was 100 and 86 s for the IMEA and the focal catheter, respectively (P = 0.183). Imprecise representation of the maximal LET was observed in 24 (60%) and 28 patients (70%) for the left and right PVs, respectively.
  
  
  CONCLUSIONS
  Due to the unknown exact lateral position of the LET probe within the oesophagus, the measured temperature does not necessarily reflect the maximal LET. The absence of LET increase does not rule out significant temperature increase within the oesophagus. Consequently, the temperature information of the linear multipolar probe should be used with caution.
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.|CRIB Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Sven
authors.initials: S
authors.lastname: Knecht
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.|CRIB Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Sticherling
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.|CRIB Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.|CRIB Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Aline
authors.initials: A
authors.lastname: Mühl
authors.affiliation: University Hospital Centre 'Sisters of Mercy', Zagreb, Croatia.
authors.forename: Nikola
authors.initials: N
authors.lastname: Pavlovic
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.|CRIB Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Schaer
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.|CRIB Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Osswald
authors.affiliation: Cardiology/Electrophysiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.|CRIB Cardiovascular Research Institute Basel, Basel, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Kühne
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001831:Body Temperature; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation*; D004947:Esophagus / Q000000981:diagnostic imaging*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D015203:Reproducibility of Results; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Luminal oesophageal temperature monitoring; Radiofrequency ablation; nMARQ