BACKGROUND: Pulmonary vein isolation is an established treatment option for atrial fibrillation. To date, the incidence and quality of ablation-induced esophageal thermal lesions (ETLs) using the recently introduced second-generation cryoballoon (CB, ArcticFront Advance, Medtronic) is unknown. METHODS AND RESULTS: In patients with drug-refractory paroxysmal atrial fibrillation or short-standing persistent atrial fibrillation, pulmonary vein (PV) isolation was performed using the second-generation CB. The endoluminal esophageal temperature was monitored via a temperature probe. After PV isolation, esophagogastroduodenoscopy (EGD) was performed to assess the incidence of ETLs. In 50 patients (18 women; age, 61±11 years; left atrial diameter, 43±5 mm), successful CB-based PV isolation was performed. Lowest median balloon temperature and esophageal temperature for the right superior PV were -51°C and 35.8°C, -47°C and 35°C for the right inferior PV, -51°C and 34.4°C for the left superior PV, -48°C and 34.6°C for the left inferior PV, and -54°C and 34.5°C for the left common PV, respectively. EGD performed 2±1 days post ablation demonstrated superficial thermal lesions and thermal ulcerations in 1 of 50 (2%) and 5 of 50 (10%) patients, respectively. In patients with ETLs, during ≥1 freeze cycle the endoluminal esophageal temperature measured <3.0°C. All thermal lesions were in the healing process on repeat EGD 4±2 days after initial endoscopy. CONCLUSIONS: Using the second-generation 28-mm CB, ETLs were detected in 6 of 50 (12%) patients. All ETLs were in the healing process on repeat EGD. An esophageal temperature safety cutoff may prove valuable in the prevention of ETLs and requires further evaluation.
BACKGROUND:Pulmonary vein isolation is an established treatment option for atrial fibrillation. To date, the incidence and quality of ablation-induced esophageal thermal lesions (ETLs) using the recently introduced second-generation cryoballoon (CB, ArcticFront Advance, Medtronic) is unknown. METHODS AND RESULTS: In patients with drug-refractory paroxysmal atrial fibrillation or short-standing persistent atrial fibrillation, pulmonary vein (PV) isolation was performed using the second-generation CB. The endoluminal esophageal temperature was monitored via a temperature probe. After PV isolation, esophagogastroduodenoscopy (EGD) was performed to assess the incidence of ETLs. In 50 patients (18 women; age, 61±11 years; left atrial diameter, 43±5 mm), successful CB-based PV isolation was performed. Lowest median balloon temperature and esophageal temperature for the right superior PV were -51°C and 35.8°C, -47°C and 35°C for the right inferior PV, -51°C and 34.4°C for the left superior PV, -48°C and 34.6°C for the left inferior PV, and -54°C and 34.5°C for the left common PV, respectively. EGD performed 2±1 days post ablation demonstrated superficial thermal lesions and thermal ulcerations in 1 of 50 (2%) and 5 of 50 (10%) patients, respectively. In patients with ETLs, during ≥1 freeze cycle the endoluminal esophageal temperature measured <3.0°C. All thermal lesions were in the healing process on repeat EGD 4±2 days after initial endoscopy. CONCLUSIONS: Using the second-generation 28-mm CB, ETLs were detected in 6 of 50 (12%) patients. All ETLs were in the healing process on repeat EGD. An esophageal temperature safety cutoff may prove valuable in the prevention of ETLs and requires further evaluation.
Authors: Alexander Bohó; Silvia Mišíková; Peter Spurný; Erika Komanová; Michal Kerekanič; Marek Hudák; Branislav Stančák Journal: Wien Klin Wochenschr Date: 2015-07-04 Impact factor: 1.704
Authors: Shaojie Chen; Boris Schmidt; Stefano Bordignon; Fabrizio Bologna; Takahiko Nagase; Laura Perrotta; K R Julian Chun Journal: Arrhythm Electrophysiol Rev Date: 2018-03
Authors: Eberhard Scholz; Patrick Lugenbiel; Patrick A Schweizer; Panagiotis Xynogalos; Claudia Seyler; Edgar Zitron; Rüdiger Becker; Hugo A Katus; Dierk Thomas Journal: J Atr Fibrillation Date: 2016-02-29