The relationship between oesophageal heating during left atrial posterior wall ablation and the durability of pulmonary vein isolation

Tran, Vân Nam; Kusa, Shigeki; Smietana, Jeffrey; Tsai, Wen‐Hui; Bhasin, Kabir; Teh, A.; Syros, George; Singh, Anurag Kumar; Choudry, Subbaro; Miller, Marc A.; Koruth, Jacob S.; Dukkipati, Srinivas; Reddy, Vivek Y.

doi:10.1093/europace/euw232

Cited by 20 publications

(12 citation statements)

References 10 publications

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“…Another important finding was the independence of recurrence rates of AF after ablation from the esophageal position or temperature. A much smaller study by Tran et al found that pulmonary vein reconnection was increased in the region of the inferior but not the superior veins, when the esophageal temperature had risen in the index procedure. As described, neither esophagus localization nor esophagus temperature influenced recurrence rates.…”

Section: Discussionmentioning

confidence: 95%

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

Stauber

Kornej

Bollmann

et al. 2020

Pacing Clinical Electrophis

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Background Thermolesions are a dangerous complication of atrial fibrillation (AF) ablation. We aimed to assess the reasons for thermolesions and the effect of esophageal position on recurrences. Methods The study included consecutive patients undergoing AF catheter ablation at Heart Center Leipzig between January and September 2014. We collected data of esophagus localization, temperature, endoscopy, and follow‐up. Results The study included 645 patients into analyses. A total of 626 (97.2%) received a temperature probe. Esophageal position was categorized: (A) behind left pulmonary veins, (B) left ostial, (C) in the middle of left atrium, (D) right ostial, and (E) behind right pulmonary veins. The most frequent esophageal position was B‐C (n = 201, 32.1%), followed by B (n = 161, 25.7%), and C (n = 147, 23.5%). The temperature was highest in A‐B positions (42.04°C) and in D‐E positions (41.70°C). There was a significant correlation between the endoscopically detected esophageal lesions (EDEL) and the esophageal position (r² = −.115, P = .004) and the esophageal temperature (r² = .162, P = .000), but not with body mass index (BMI) (r² = −.016, P = .688). Additional substrate modification in the left atrium resulted in significantly higher esophageal temperatures (P < .001) and more frequent EDEL (P = .049). An EDEL was found in 15 patients (2.3% of all patients, 5.6% of patients receiving endoscopy). Of those, the median esophageal temperature was 41.8°C (interquartile range [IQR]: 41.2‐42.4). Neither esophageal position nor temperature during ablation was associated with arrhythmia recurrences (both P > .400). Conclusions EDEL depended on the esophageal position and temperature, but not on BMI. Esophageal position and intraluminal temperature during ablation had no effect on recurrences.

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Section: Discussionmentioning

confidence: 95%

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

Stauber

Kornej

Bollmann

et al. 2020

Pacing Clinical Electrophis

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“…The risk is present with standard PV circumferential ablation with no evidence to suggest that PWI increases this risk. In accordance with the 2017 HRS guidelines, an esophageal temperature probe is recommended, although recent evidence suggests that it may lead to increased reconnection at sites of increased temp recordings …”

Section: Discussionmentioning

confidence: 99%

How to perform posterior wall isolation in catheter ablation for atrial fibrillation

Sugumar

Thomas

Prabhu

et al. 2017

Cardiovasc electrophysiol

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Catheter ablation has become standard of care in patients with symptomatic atrial fibrillation (AF). Although there have been significant advances in our understanding and technology, a substantial proportion of patients have ongoing AF requiring repeat procedures. Pulmonary vein isolation (PVI) is the cornerstone of AF ablation; however, it is less effective in patients with persistent as opposed to paroxysmal atrial fibrillation. Left atrial posterior wall isolation (PWI) is commonly performed as an adjunct to PVI in patients with persistent AF with nonrandomized studies showing improved outcomes. Anatomical considerations and detailed outline of the various approaches and techniques to performing PWI are detailed, and advantages and pitfalls to assist the clinical electrophysiologist successfully and safely complete PWI are described.

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“…Methods to prevent injury should be utilized such as temperature monitoring, power reduction, esophageal deviation or active esophageal cooling. We currently utilize temperature probe monitoring and power reduction although no strong evidence exists that monitoring reduces AEF formation and it could result in impaired lesion formation through operator changes in lesion delivery 20 . Esophageal cooling could be a promising alternative and is actively being investigated.…”

Section: Coronary Sinus Isolationmentioning

confidence: 99%

Long-standing Persistent Atrial Fibrillation Ablation: How do You Perform it?

Smietana

2020

J Cardiac Arrhtythmias

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Catheter ablation of long-standing persistent atrial fibrillation (LSPAF) presents unique challenges and the lack of large body of evidence surrounding management makes for disagreement and different approaches for treatment. Outlined is a case example that offers a comprehensive approach to ablation in patients with LSPAF that consists of risk factor management, an ablation strategy, a rigorous trigger protocol and follow-up rhythm monitoring. The case presented highlights management of this difficult population as best guided by current evidence and our experience. Ablation treatment and management strategies will continue to evolve with further randomized data and the advent of improved ablation technologies.

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The relationship between oesophageal heating during left atrial posterior wall ablation and the durability of pulmonary vein isolation

Abstract: Pulmonary vein reconnections are predominantly posteriorly located. Along the right- and left-inferior PW segments, there was an association with elevated oesophageal temperature during the index procedure.

Cited by 20 publications

References 10 publications

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations

How to perform posterior wall isolation in catheter ablation for atrial fibrillation

Long-standing Persistent Atrial Fibrillation Ablation: How do You Perform it?

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