Objective: Atrio-esophageal fistula is an infrequent but devastating complication of catheter-based ablation of atrial fibrillation (AF). Thermal esophageal injury may be the precursor of atrio-esophageal fistula. Here, we evaluated the role of esophageal temperature monitoring in preventing thermal esophageal injury during pulmonary vein isolation for AF with radiofrequency energy. Methods: In this meta-analysis, we searched the PubMed, Cochrane, Scopus, Embase, and Refworks databases for all published studies from January 2004 to June 2016 to evaluate the role of esophageal temperature monitoring. We searched for terms esophageal temperature monitoring, AF, radiofrequency ablation, atrio-esophageal fistula, and thermal esophageal injury. We included studies comparing luminal esophageal temperature (LET) monitoring with no LET monitoring during radiofrequency ablation of AF. We excluded studies in which post-ablation esophagogastroduodenoscopy (EGD) was not performed to identify esophageal thermal injuries. To perform the meta-analysis, we used Review Manager statistical software and a fixed-effects modeling to derive the outcomes. Given significant heterogeneity between the studies, we used meta-regression analysis to adjust for age and sex. Results: We identified 4 non-randomized controlled trials that met our search criteria and included a total of 411 patients (n=235 in the LET monitoring group; n=176 in the no LET monitoring group) in the analysis. There were 21 (8.9%) patients with thermal esophageal injury in the LET monitoring group and 12 (6.8%) in the no LET monitoring group. The pooled odds ratio was 0.66 (0.23-1.89), indicating no statistically significant differences between the 2 groups with regard to esophageal injury. Because of the small sample size and the non-randomized nature of the trials, we observed significant heterogeneity in outcomes among the trials. Conclusion: The role of esophageal temperature monitoring in reducing the risk of esophageal thermal lesions during pulmonary vein isolation for AF has not been established, and more studies including randomized controlled trials are needed to assess its true impact.
Objective: Atrio-esophageal fistula is an infrequent but devastating complication of catheter-based ablation of atrial fibrillation (AF). Thermal esophageal injury may be the precursor of atrio-esophageal fistula. Here, we evaluated the role of esophageal temperature monitoring in preventing thermal esophageal injury during pulmonary vein isolation for AF with radiofrequency energy. Methods: In this meta-analysis, we searched the PubMed, Cochrane, Scopus, Embase, and Refworks databases for all published studies from January 2004 to June 2016 to evaluate the role of esophageal temperature monitoring. We searched for terms esophageal temperature monitoring, AF, radiofrequency ablation, atrio-esophageal fistula, and thermal esophageal injury. We included studies comparing luminal esophageal temperature (LET) monitoring with no LET monitoring during radiofrequency ablation of AF. We excluded studies in which post-ablation esophagogastroduodenoscopy (EGD) was not performed to identify esophageal thermal injuries. To perform the meta-analysis, we used Review Manager statistical software and a fixed-effects modeling to derive the outcomes. Given significant heterogeneity between the studies, we used meta-regression analysis to adjust for age and sex. Results: We identified 4 non-randomized controlled trials that met our search criteria and included a total of 411 patients (n=235 in the LET monitoring group; n=176 in the no LET monitoring group) in the analysis. There were 21 (8.9%) patients with thermal esophageal injury in the LET monitoring group and 12 (6.8%) in the no LET monitoring group. The pooled odds ratio was 0.66 (0.23-1.89), indicating no statistically significant differences between the 2 groups with regard to esophageal injury. Because of the small sample size and the non-randomized nature of the trials, we observed significant heterogeneity in outcomes among the trials. Conclusion: The role of esophageal temperature monitoring in reducing the risk of esophageal thermal lesions during pulmonary vein isolation for AF has not been established, and more studies including randomized controlled trials are needed to assess its true impact.
Authors: Patrick Müller; Johannes-Wolfgang Dietrich; Philipp Halbfass; Aly Abouarab; Franziska Fochler; Atilla Szöllösi; Karin Nentwich; Markus Roos; Joachim Krug; Anja Schade; Andreas Mügge; Thomas Deneke Journal: Heart Rhythm Date: 2015-04-03 Impact factor: 6.343
Authors: Jacob S Koruth; Vivek Y Reddy; Marc A Miller; Kalpesh K Patel; James O Coffey; Avi Fischer; J Anthony Gomes; Srinivas Dukkipati; Andre D'Avila; Alexander Mittnacht Journal: J Cardiovasc Electrophysiol Date: 2011-09-13
Authors: Thomas Deneke; Kathrin Bünz; Annely Bastian; Marcus Päsler; Helge Anders; Rainer Lehmann; Wolfgang Meuser; Joris R de Groot; Marc Horlitz; Ron Haberkorn; Andreas Mügge; Dong-In Shin Journal: J Cardiovasc Electrophysiol Date: 2010-10-11
Authors: Jennifer E Cummings; Conor D Barrett; Kenneth N Litwak; Luigi DI Biase; Punam Chowdhury; Seil Oh; Chi Keong Ching; Walid I Saliba; Robert A Schweikert; J David Burkhardt; Shari DE Marco; Luciana Armaganijan; Andrea Natale Journal: J Cardiovasc Electrophysiol Date: 2008-03-26
Authors: Charlotte Eitel; Sascha Rolf; Markus Zachäus; Silke John; Philipp Sommer; Andreas Bollmann; Arash Arya; Christopher Piorkowski; Gerhard Hindricks; Ulrich Halm Journal: Circ Arrhythm Electrophysiol Date: 2013-05-31
Authors: Aman Chugh; Joel Rubenstein; Eric Good; Matthew Ebinger; Krit Jongnarangsin; Jackie Fortino; Frank Bogun; Frank Pelosi; Hakan Oral; Timothy Nostrant; Fred Morady Journal: Heart Rhythm Date: 2008-12-07 Impact factor: 6.343
Authors: Lars Eckardt; Florian Doldi; D Steven; P Sommer; Sonia Busch; David Duncker; H Estner; M Kuniss; A Metzner; C Meyer; H-R Neuberger; R Tilz; F Voss Journal: Clin Res Cardiol Date: 2022-09-06 Impact factor: 6.138