Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium

• Published in: Circulation (New York, N.Y.) N.Y.), 2005-07, Vol.112 (4), p.459-464
• Main Authors: CUMMINGS, Jennifer E, SCHWEIKERT, Robert A, KILICASLAN, Fethi, NATALE, Andrea, SALIBA, Walid I, BURKHARDT, J. David, BRACHMANN, Johannes, GUNTHER, Jens, SCHIBGILLA, Volker, VERMA, Atul, DERY, Markalain, DRAGO, John L
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atrial Fibrillation - surgery; Biological and medical sciences; Blood and lymphatic vessels; Body Temperature; Cardiology. Vascular system; Cardiovascular system; Catheter Ablation - adverse effects; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Emergency and intensive care: renal failure. Dialysis management; Esophagus - pathology; Esophagus - physiopathology; Female; Heart Atria; Humans; Intensive care medicine; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Pulmonary Veins - surgery
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circulationaha.104.509612

Left atrioesophageal fistula is a devastating complication of atrial fibrillation ablation. There is no standard approach for avoiding this complication, which is caused by thermal injury during ablation. The objectives of this study were to evaluate the course of the esophagus and the temperature within the esophagus during pulmonary vein antrum isolation (PVAI) and correlate these data with esophagus tissue damage. Eight-one patients presenting for PVAI underwent esophagus evaluation that included temperature probe placement. Esophagus course was obtained with computed tomography, 3D imaging (NAVX), or intracardiac echocardiography. For each lesion, the power, catheter and esophagus temperature, location, and presence of microbubbles were recorded. Lesion location and esophagus course were defined with 6 predetermined left atrial anatomic segments. Endoscopy evaluated tissue changes during and after PVAI. Of 81 patients, the esophagus coursed near the right pulmonary veins in 23 (28.4%), left pulmonary veins in 31 (38.3%), and mid-posterior wall in 27 (33%). Esophagus temperature was significantly higher during left atrial lesions along its course than with lesions elsewhere (38.9+/-1.4 degrees C, 36.8+/-0.5 degrees C, P