Abstract 2321: Esophageal Temperature Monitoring and Incidence of Esophageal Lesions in Patients With Pulmonary Vein Isolation Using a Remote Robotic Navigation System
Background Esophageal lesions as a complication of pulmonary vein isolation (PVI) have been described recently. The introduction of a new remote robotic navigation system (RNS; Hansen medical) provides enhanced catheter stability and more effective lesion size. The incidence of esophageal lesions might increase with use of the RNS. The aim of this prospective study was to evaluate temperature monitoring and incidence of esophageal lesions when using the RNS for circumferential PVI.
Methods PVI using the RNS was performed in 51 patients (pts) with paroxysmal (n=31, 60,8%) and persistent atrial fibrillation. An esophageal temperature probe was placed in 42 (82,4%) pts and was integrated in the 3D-map (NAVX); the course of the esophageus was visualized both by fluoroscopy and 3D-imaging and the esophageal temperature was continuously assessed during the procedure. At the posterior wall power was limited to 25 watts, and in the case of a rise in temperature power was limited to 20 watts. In 25 pts endoscopy was performed within 24h after PVI.
Results In 34/42 (81%) pts a rise in temperature was observed with a maximum temperature of 42,8 C°. A rise in temperature >40°C occurred significantly more often in patients with lower BMI (26,9±4,1 vs 29,9±5,3, p= 0,048) and smaller left atrial diameter (4,2±0,7 mm vs 4,8±0,7 mm, p=0,017). In 3 (12%) pts an esophageal ulcus was found during endoscopy after PVI. The esophageal lesions showed brisk healing after re-endoscopy within 2 weeks in all pts. No atrial-esophageal fistula occured. There were no significant differences between pts with or without esophageal lesions with regard to age, duration of AF or radiofrequency application time at the posterior wall.
Conclusion In patients with lower BMI and smaller left atrial diameter the incidence of a rise in temperature >40°C was significantly higher. In patients undergoing PVI using the RNS with a maximum power of 20 watts at the posterior wall, the incidence of esophageal lesions (12%) is increased compared to treatment using other energy sources. The optimal power setting for ablation at the posterior wall using the RNS must be more precisely determined.