Abstract 5657: Esophageal Temperature Monitoring during Balloon Cryoablation of the Pulmonary Veins
Introduction: Atrial-esophageal fistula is a feared complication of atrial fibrillation (AF) ablation. There have been no reported instances after ablation with the Cryoballoon catheter, which is believed to be associated with a relatively low risk of thromboembolism and PV stenosis, and no risk of atrial perforation. Yet, given the high frequency of subclinical esophageal ulceration reported with radiofrequency energy, we sought to determine the effect of cryoenergy on the esophagus.
Methods: Catheter ablation was performed using the cryoballoon in 50 pts with paroxysmal AF (Age: 56±10 years, 29 male/21 female, LVEF: 67±6%, LA size 40±5mm). A temperature probe was used to monitor LET; however, LET changes did not guide therapy. Post-procedural endoscopy was systematically performed on the last 25 consecutive pts.
Results: Significant (>1°C) LET drops were observed in 48 (96%) patients (5±3 per patient). The greatest mean LET drop was observed in the LIPV (3.5°C), followed by the RIPV (2.7°C), LSPV (2.1°C) and RSPV (0.9°C). The LET nadir (13.8°C) was observed in the RIPV. Esophageal ulceration was observed in 4/25 (16%) pts; all were asymptomatic and prescribed proton pump inhibitors. Follow-up EGDs at one month revealed complete resolution of ulceration. No patient or procedural characteristics (age, history of GERD, LA size, LVEF, pre-procedural TEE) predicted ulceration. A significant correlation was found between the incidence of esophageal ulceration and
number of LETs <30°C, and
cumulative LET drop (Figure⇓).
Conclusion: Esophageal ulceration can occur after balloon cryoablation; however, in no instances did this progress to fistula formation.