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Limiting esophageal temperature in radiofrequency ablation of left atrial tachyarrhythmias results in low incidence of thermal esophageal lesions

DOI: 10.1186/1471-2261-10-52

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Abstract:

184 consecutive patients underwent open irrigated radiofrequency ablation of left atrial tachyarrhythmias. An esophageal temperature probe consisting of three independent thermocouples was used for temperature monitoring. A temperature limit of 40°C was defined to interrupt energy delivery. All patients underwent esophageal endoscopy the next day.Endoscopy revealed ulcer formation in 3/184 patients (1.6%). No patient developed atrio-esophageal fistula. Patient and disease characteristics had no influence on ulcer formation. The temperature threshold of 40°C was reached in 157/184 patients. A temperature overshoot after cessation of energy delivery was observed frequently. The mean maximal temperature was 40.8°C. Using a multiple regression analysis creating a box lesion that implies superior- and inferior lines at the posterior wall connecting the right and left encircling was an independent predictor of temperature. Six month follow-up showed an overall success rate of 78% documented as sinus rhythm in seven-day holter ECG.Limitation of esophageal temperature to 40°C is associated with the lowest incidence of esophageal lesion formation published so far. This approach may contribute to increase the safety profile of radiofrequency ablation in the left atrium.Pulmonary vein antrum isolation using radiofrequency ablation has become an effective therapy in symptomatic patients with atrial fibrillation. Additional linear ablation in the left atrium is performed in persistent atrial fibrillation and atrial flutter. Non-lethal complications such as cardiac perforation, stroke and pulmonary vein stenosis have been reported to occur with rates of 1.3%, 0.2% and 1.3% respectively [1,2]. A recently reported complication describes esophageal injury leading to left atrial esophageal fistula. Despite its low incidence (0.03-0.1%) this usually lethal complication is of tremendous clinical importance [3-7]. Other serious esophageal injuries include vagus nerve damage with acute p

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