title: The relationship between oesophageal heating during left atrial posterior wall ablation and the durability of pulmonary vein isolation.
abstract: OBJECTIVE
  During ablation of the posterior wall (PW), luminal oesophageal temperature elevation (OTE) prompts attenuation of radiofrequency (RF) energy delivery to minimize oesophageal injury. This strategy on lesion efficacy is unknown. The goal of this study was to analyse the relationship between OTE and pulmonary vein reconnection (PVR).
  
  
  RESULTS
  During the index antral pulmonary vein (PV) isolation procedure with an irrigated RF ablation catheter, OTE was detected with a multisensor oesophageal temperature probe. Posterior wall ablation did not exceed 25 W and was terminated when the temperature was ≥38.5°C. Patients undergoing redo procedures (n = 142) were studied for PW sites of PVR along 4 segments: left and right superior, and left and right inferior. Pulmonary vein reconnections had occurred in 51 of the 142 patients (36%), in 58 of 284 PV pairs (20%). Among these 58 reconnected pairs, 83% (n = 48) were along the PW. Oesophageal temperature elevation had occurred in 30 patients (59%). No difference in characteristics was seen between the patients with OTE (n = 30) and those without (n = 21). For superior segments, there was no interaction between the presence or absence of OTE and PVR. For inferior segments, there were more PVRs in the group with OTE: for the right-inferior segment, the PVR rate was 72% for OTE cases vs. 42% without (P = 0.04), and for the left-inferior segment, the PVR rate was 44% for OTE cases vs. 22.9% without (P = 0.12).
  
  
  CONCLUSIONS
  Pulmonary vein reconnections are predominantly posteriorly located. Along the right- and left-inferior PW segments, there was an association with elevated oesophageal temperature during the index procedure.
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: V Nam
authors.initials: VN
authors.lastname: Tran
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Kusa
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Smietana
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Tsai
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Kabir
authors.initials: K
authors.lastname: Bhasin
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Teh
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: George
authors.initials: G
authors.lastname: Syros
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Anurag
authors.initials: A
authors.lastname: Singh
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Subbaro
authors.initials: S
authors.lastname: Choudry
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Miller
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Jacob
authors.initials: J
authors.lastname: Koruth
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: D'Avila
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Srinivas D
authors.initials: SD
authors.lastname: Dukkipati
authors.affiliation: Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, NY 10029, USA.
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001833:Body Temperature Regulation; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D004947:Esophagus / Q000293:injuries / Q000503:physiopathology*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000295:instrumentation; D062125:Thermometry; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Oesophageal injury; Oesophageal temperature monitoring; Pulmonary veins reconnection; Radiofrequency ablation