Abstract 14295: Adequate Esophageal Preset Temperature for Sufficient Ablation Lesion Formation while Avoiding Digestive-organ Complications During Catheter Pulmonary Vein Isolation
Background: During catheter based pulmonary vein isolation (PVI) of atrial fibrillation (AF), monitoring the luminal esophageal temperature (ET) and interrupting energy deliveries at preset temperatures are reported to decrease potential esophageal damage, however, the influence of such premature termination on the ablation lesion formation remains unknown. We sought to determine the adequate preset ET to create sufficient lesions for PVI while avoiding digestive-organ complications.
Methods: This prospective study consisted of 100 consecutive patients (63±11yrs), in whom the ET reached the preset temperature at left atrial posterior sites during the left PVI. The patients were equally divided into four groups by the preset ETs (41°C, 40°C, 39.5°C, and 39°C groups). A 40 sec point-to-point energy delivery with 5-mm distance between each ablation site was performed. If the ET, monitored with single-thermocouple probes, reached the preset temperature, the energy application was immediately stopped and the precise location of the site (ET-site) was recorded on an electroanatomical mapping system. An energy delivery at the ET-site was repeated if circumferential energy applications could not achieve PVI. The rate of repeat energy deliveries at ET-sites for PVI and incidence of digestive organ complications were evaluated.
Results: A total of 407 ET-sites were observed (4.1±2.6 sites/patient). The number of ET-sites did not differ among the four groups (P=0.10). Repeat energy applications at ET-sites were required to achieve PVI in 0 (0%), 2 (8%), 4 (16%), and 8 (32%) patients in the 41°C, 40°C, 39.5°C, and 39°C groups, respectively, and were significantly more frequent in the lower preset ET group (P<0.001). Periesophageal vagal nerve injury developed after the session in two 41°C group patients (8%). In an additional 55 AF patients, catheter PVI was performed with a 39.5°C preset ET. Repeat energy deliveries at the ET-sites were required for PVI in 8 patients (15%), and no digestive-organ complications occurred.
Conclusion: During circumferential left PVI for AF, lower preset ETs were safe but more frequently required a repeat ablation at sites where the energy delivery was interrupted for an ET elevation. A 39.5°C preset ET was shown to be adequate.
- © 2013 by American Heart Association, Inc.