Published Online
on July 18, 2005

A more recent version of this article appeared on July 26, 2005

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Submitted on September 27, 2004
Revised on April 1, 2005
Accepted on April 12, 2005

Assessment of Temperature, Proximity, and Course of the Esophagus During Radiofrequency Ablation Within the Left Atrium

Jennifer E. Cummings MD, Robert A. Schweikert MD, Walid I. Saliba MD, J. David Burkhardt MD, Johannes Brachmann MD, Jens Gunther MD, Volker Schibgilla MD, Atul Verma MD, MarkAlain Dery DO, MPH, John L. Drago , Fethi Kilicaslan MD, and Andrea Natale MD^*

From the Department of Cardiovascular Medicine (J.E.C., R.A.S., W.I.S., J.D.B., A.V., M.A.D., J.L.D., F.K., A.N.), Section of Pacing and Electrophysiology, The Cleveland Clinic Foundation, Cleveland, Ohio, and Klinicum Coburg (J.B., J.G., V.S.), Coburg, Germany.

^* To whom correspondence should be addressed. E-mail: natalea{at}ccf.org.

Background--Left atrioesophageal fistula is a devastating complication of atrial fibrillation ablation. There is no standard approach for avoiding this complication, which is caused by thermal injury during ablation. The objectives of this study were to evaluate the course of the esophagus and the temperature within the esophagus during pulmonary vein antrum isolation (PVAI) and correlate these data with esophagus tissue damage.

Methods and Results--Eight-one patients presenting for PVAI underwent esophagus evaluation that included temperature probe placement. Esophagus course was obtained with computed tomography, 3D imaging (NAVX), or intracardiac echocardiography. For each lesion, the power, catheter and esophagus temperature, location, and presence of microbubbles were recorded. Lesion location and esophagus course were defined with 6 predetermined left atrial anatomic segments. Endoscopy evaluated tissue changes during and after PVAI. Of 81 patients, the esophagus coursed near the right pulmonary veins in 23 (28.4%), left pulmonary veins in 31 (38.3%), and mid-posterior wall in 27 (33%). Esophagus temperature was significantly higher during left atrial lesions along its course than with lesions elsewhere (38.9±1.4°C, 36.8±0.5°C, P<0.01). Lesions that generated microbubbles had higher esophagus temperatures than those without (39.3±1.5°C, 38.5±0.9°C, P<0.01). Power was not predictive of esophagus temperatures. Distance between the esophagus and left atrium was 4.4±1.2 mm.

Conclusions--Lesions near the course of the esophagus that generated microbubbles significantly increased esophagus temperature compared with lesions that did not. Power did not correlate with esophagus temperatures. Esophagus variability makes the avoidance of lesions along its course difficult. Rather than avoiding posterior lesions, emphasis could be placed on better esophagus monitoring for creation of safer lesions.

Key words: ablation • catheter ablation • complications • fistula, atrioesophageal • pulmonary veins

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