Abstract 2320: Esophageal Temperature and Lesions After Remote Controlled Magnetic Pulmonary Vein Isolation. Initial Experience
Introduction The most ferocious complication after manual radiofrequency (RF) current catheter ablation of atrial fibrillation (AF) is the rare but most often lethal atrio-esophageal fistula (AEF). The magnetic navigation system (MNS) utilizes a soft catheter thereby avoiding strong mechanical pushing forces. No data is available on esophageal temperature (ET) and lesions after ablation utilising the MNS.
Methods Wide area circumferential pulmonary vein isolation (PVI) of both ipsilateral veins was performed using the MNS and the magnetic 3.5 mm irrigated tip catheter (Biosense Webster, Navistar Thermocool RMT). ET was monitored during the RF applications in left atrial (LA) posterior wall, with a temperature probe (Sensitherm TM, St Jude Medical) equipped with 3 temperature sensors which were placed radiographically close to the ablation site. RF ablation energy settings were limited to 30W with 17ml/min flush rate (posterior wall) and to 40W with 30ml/min flush rate (anterior wall). The operator was blinded for ET. Endoscopy was performed after the procedure in all patients (pts) to screen for potential thermal lesions.
Results We included 6 pts (5 males, age 60 + 8 years, LA 43 + 5.4 mm) undergoing MNS RF catheter ablation for AF with real time monitoring of ET. Median ET during septal PVI was 36.9°C (range 35.8 – 41.3°C) and mean energy applied 60082 + 8412.5 J. Maximal ET was monitored during ablation at mid-posterior LA wall. Median ET during lateral PVI was 39.3 °C (range 36.9 –51.7°C) and mean energy applied 35392 + 10167.4 J. Maximal ET was observed during ablation along the posterior LA, specifically close to the left inferior PV. All pts had endoscopy at day 2 after the ablation procedure. In 2/6 pts thermal lesions were detected after MNS ablation: 2 pinpoint erosions (pt#1) and one ulceration (pt#4). No AEF did occur.
Conclusion Remote controlled magnetic PVI is associated with thermal esophageal lesions.