Skip to main content
Top
Published in: Journal of Interventional Cardiac Electrophysiology 3/2014

01-04-2014

Incidences of esophageal injury during esophageal temperature monitoring: a comparative study of a multi-thermocouple temperature probe and a deflectable temperature probe in atrial fibrillation ablation

Authors: Taishi Kuwahara, Atsushi Takahashi, Yoshihide Takahashi, Kenji Okubo, Katsumasa Takagi, Tadashi Fujino, Shigeki Kusa, Masateru Takigawa, Yuji Watari, Kazuya Yamao, Emiko Nakashima, Naohiko Kawaguchi, Hiroyuki Hikita, Akira Sato, Kazutaka Aonuma

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2014

Login to get access

Abstract

Purpose

The study aim was to compare the incidence of esophageal injuries between different temperature probes in the monitoring of esophageal temperature during atrial fibrillation (AF) ablation.

Methods

One hundred patients with drug-resistant AF were prospectively and randomly assigned into two groups according to the esophageal temperature probe used: the multi-thermocouple probe group (n = 50) and the deflectable temperature probe group (n = 50). Extensive pulmonary vein (PV) isolation was performed with a 3.5-mm open irrigated tip ablation catheter by using a radiofrequency (RF) power of 25–30 W. In both groups, the esophageal temperature thermocouple was placed on the area of the esophagus adjacent to the ablation site. When the esophageal temperature reached 42 °C, the RF energy delivery was stopped. Esophageal endoscopy was performed 1 day after the catheter ablation.

Results

No differences existed between the two groups in terms of clinical background and various parameters related to the catheter ablation, including RF delivery time and number of RF deliveries at an esophageal temperature of >42 °C. Esophageal lesions, such as esophagitis and esophageal ulcers, occurred in 10/50 (20 %) and 15/50 (30 %) patients in the multi-thermocouple and deflectable temperature probe groups, respectively (P = 0.25). Most lesions were mild to moderate injuries, and all were cured using conservative treatment.

Conclusion

The incidence of esophageal injury was almost equal between the multi-thermocouple temperature probe and the deflectable temperature probe during esophageal temperature monitoring. Most of the esophageal lesions that developed during esophageal temperature monitoring were mild to moderate and reversible.
Literature
1.
go back to reference Cappato, R., Calkins, H., Chen, S.-A., Davies, W., Iesaka, Y., Kalman, J., et al. (2009). Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. Journal of the American College of Cardiology, 53(19), 1798–1803.PubMedCrossRef Cappato, R., Calkins, H., Chen, S.-A., Davies, W., Iesaka, Y., Kalman, J., et al. (2009). Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. Journal of the American College of Cardiology, 53(19), 1798–1803.PubMedCrossRef
2.
go back to reference Kuwahara, T., Takahashi, A., Kobori, A., Miyazaki, S., Takahashi, Y., Takei, A., et al. (2009). Safe and effective ablation of atrial fibrillation: importance of esophageal temperature monitoring to avoid periesophageal nerve injury as a complication of pulmonary vein isolation. Journal of Cardiovascular Electrophysiology, 20(1), 1–6.PubMedCrossRef Kuwahara, T., Takahashi, A., Kobori, A., Miyazaki, S., Takahashi, Y., Takei, A., et al. (2009). Safe and effective ablation of atrial fibrillation: importance of esophageal temperature monitoring to avoid periesophageal nerve injury as a complication of pulmonary vein isolation. Journal of Cardiovascular Electrophysiology, 20(1), 1–6.PubMedCrossRef
3.
go back to reference Schmidt, M., Nölker, G., Marschang, H., Gutleben, K.-J., Schibgilla, V., Rittger, H., et al. (2008). Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation. Europace, 10(2), 205–209.PubMedCrossRef Schmidt, M., Nölker, G., Marschang, H., Gutleben, K.-J., Schibgilla, V., Rittger, H., et al. (2008). Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation. Europace, 10(2), 205–209.PubMedCrossRef
4.
go back to reference Singh, S. M., D’ Avila, A., Doshi, S. K., Brugge, W. R., Bedford, R. A., Mela, T., et al. (2008). Esophageal injury and temperature monitoring during atrial fibrillation ablation. Circulation Arrhythmia and Electrophysiology, 1(3), 162–168.PubMedCrossRef Singh, S. M., D’ Avila, A., Doshi, S. K., Brugge, W. R., Bedford, R. A., Mela, T., et al. (2008). Esophageal injury and temperature monitoring during atrial fibrillation ablation. Circulation Arrhythmia and Electrophysiology, 1(3), 162–168.PubMedCrossRef
5.
go back to reference Di Biase, L., Saenz, L. C., Burkhardt, D. J., Vacca, M., Elayi, C. S., Barrett, C. D., et al. (2009). Esophageal capsule endoscopy after radiofrequency catheter ablation for atrial fibrillation: documented higher risk of luminal esophageal damage with general anesthesia as compared with conscious sedation. Circulation. Arrhythmia and Electrophysiology, 2(2), 108–112.PubMedCrossRef Di Biase, L., Saenz, L. C., Burkhardt, D. J., Vacca, M., Elayi, C. S., Barrett, C. D., et al. (2009). Esophageal capsule endoscopy after radiofrequency catheter ablation for atrial fibrillation: documented higher risk of luminal esophageal damage with general anesthesia as compared with conscious sedation. Circulation. Arrhythmia and Electrophysiology, 2(2), 108–112.PubMedCrossRef
6.
go back to reference Martinek, M., Bencsik, G., Aichinger, J., Hassanein, S., Schoefl, R., Kuchinka, P., et al. (2009). Esophageal damage during radiofrequency ablation of atrial fibrillation: impact of energy settings, lesion sets, and esophageal visualization. Journal of Cardiovascular Electrophysiology, 20(7), 726–733.PubMedCrossRef Martinek, M., Bencsik, G., Aichinger, J., Hassanein, S., Schoefl, R., Kuchinka, P., et al. (2009). Esophageal damage during radiofrequency ablation of atrial fibrillation: impact of energy settings, lesion sets, and esophageal visualization. Journal of Cardiovascular Electrophysiology, 20(7), 726–733.PubMedCrossRef
7.
go back to reference Sause, A., Tutdibi, O., Pomsel, K., Dinh, W., Füth, R., Lankisch, M., et al. (2010). Limiting esophageal temperature in radiofrequency ablation of left atrial tachyarrhythmias results in low incidence of thermal esophageal lesions. BMC Cardiovascular Disorders, 10, 52.PubMedCentralPubMedCrossRef Sause, A., Tutdibi, O., Pomsel, K., Dinh, W., Füth, R., Lankisch, M., et al. (2010). Limiting esophageal temperature in radiofrequency ablation of left atrial tachyarrhythmias results in low incidence of thermal esophageal lesions. BMC Cardiovascular Disorders, 10, 52.PubMedCentralPubMedCrossRef
8.
go back to reference Martinek, M., Meyer, C., Hassanein, S., Aichinger, J., Bencsik, G., Schoefl, R., et al. (2010). Identification of a high-risk population for esophageal injury during radiofrequency catheter ablation of atrial fibrillation: procedural and anatomical considerations. Heart Rhythm, 7(9), 1224–1230.PubMedCrossRef Martinek, M., Meyer, C., Hassanein, S., Aichinger, J., Bencsik, G., Schoefl, R., et al. (2010). Identification of a high-risk population for esophageal injury during radiofrequency catheter ablation of atrial fibrillation: procedural and anatomical considerations. Heart Rhythm, 7(9), 1224–1230.PubMedCrossRef
9.
go back to reference Yamasaki, H., Tada, H., Sekiguchi, Y., Igarashi, M., Arimoto, T., Machino, T., et al. (2011). Prevalence and characteristics of asymptomatic excessive transmural injury after radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm, 8(6), 826–832.PubMedCrossRef Yamasaki, H., Tada, H., Sekiguchi, Y., Igarashi, M., Arimoto, T., Machino, T., et al. (2011). Prevalence and characteristics of asymptomatic excessive transmural injury after radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm, 8(6), 826–832.PubMedCrossRef
10.
go back to reference Cummings, J. E., Schweikert, R. A., Saliba, W. I., Burkhardt, J. D., Brachmann, J., Gunther, J., et al. (2005). Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium. Circulation, 112(4), 459–464.PubMedCrossRef Cummings, J. E., Schweikert, R. A., Saliba, W. I., Burkhardt, J. D., Brachmann, J., Gunther, J., et al. (2005). Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium. Circulation, 112(4), 459–464.PubMedCrossRef
11.
go back to reference Tsuchiya, T., Ashikaga, K., Nakagawa, S., Hayashida, K., & Kugimiya, H. (2007). Atrial fibrillation ablation with esophageal cooling with a cooled water-irrigated intraesophageal balloon: a pilot study. Journal of Cardiovascular Electrophysiology, 18(2), 145–150.PubMedCrossRef Tsuchiya, T., Ashikaga, K., Nakagawa, S., Hayashida, K., & Kugimiya, H. (2007). Atrial fibrillation ablation with esophageal cooling with a cooled water-irrigated intraesophageal balloon: a pilot study. Journal of Cardiovascular Electrophysiology, 18(2), 145–150.PubMedCrossRef
12.
go back to reference Arruda, M. S., Armaganijan, L., Di Biase, L., Rashidi, R., & Natale, A. (2009). Feasibility and safety of using an esophageal protective system to eliminate esophageal thermal injury: implications on atrial-esophageal fistula following AF ablation. Journal of Cardiovascular Electrophysiology, 20(11), 1272–1278.PubMedCrossRef Arruda, M. S., Armaganijan, L., Di Biase, L., Rashidi, R., & Natale, A. (2009). Feasibility and safety of using an esophageal protective system to eliminate esophageal thermal injury: implications on atrial-esophageal fistula following AF ablation. Journal of Cardiovascular Electrophysiology, 20(11), 1272–1278.PubMedCrossRef
13.
go back to reference Leite, L. R., Santos, S. N., Maia, H., Henz, B. D., Giuseppin, F., Oliverira, A., et al. (2011). Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study. Circulation. Arrhythmia and Electrophysiology, 4(2), 149–156.PubMedCrossRef Leite, L. R., Santos, S. N., Maia, H., Henz, B. D., Giuseppin, F., Oliverira, A., et al. (2011). Luminal esophageal temperature monitoring with a deflectable esophageal temperature probe and intracardiac echocardiography may reduce esophageal injury during atrial fibrillation ablation procedures: results of a pilot study. Circulation. Arrhythmia and Electrophysiology, 4(2), 149–156.PubMedCrossRef
14.
go back to reference Tilz, R. R., Chun, K. R. J., Metzner, A., Burchard, A., Wissner, E., Koektuerk, B., et al. (2010). Unexpected high incidence of esophageal injury following pulmonary vein isolation using robotic navigation. Journal of Cardiovascular Electrophysiology, 21(8), 853–858.PubMed Tilz, R. R., Chun, K. R. J., Metzner, A., Burchard, A., Wissner, E., Koektuerk, B., et al. (2010). Unexpected high incidence of esophageal injury following pulmonary vein isolation using robotic navigation. Journal of Cardiovascular Electrophysiology, 21(8), 853–858.PubMed
15.
go back to reference Zellerhoff, S., Ullerich, H., Lenze, F., Meister, T., Wasmer, K., Mönnig, G., et al. (2010). Damage to the esophagus after atrial fibrillation ablation: Just the tip of the iceberg? High prevalence of mediastinal changes diagnosed by endosonography. Circulation Arrhythmia and Electrophysiology, 3(2), 155–159.PubMedCrossRef Zellerhoff, S., Ullerich, H., Lenze, F., Meister, T., Wasmer, K., Mönnig, G., et al. (2010). Damage to the esophagus after atrial fibrillation ablation: Just the tip of the iceberg? High prevalence of mediastinal changes diagnosed by endosonography. Circulation Arrhythmia and Electrophysiology, 3(2), 155–159.PubMedCrossRef
16.
go back to reference Di Biase, L., Dodig, M., Saliba, W., Siu, A., Santisi, J., Poe, S., et al. (2010). Capsule endoscopy in examination of esophagus for lesions after radiofrequency catheter ablation: a potential tool to select patients with increased risk of complications. Journal of Cardiovascular Electrophysiology, 21(8), 839–844.PubMed Di Biase, L., Dodig, M., Saliba, W., Siu, A., Santisi, J., Poe, S., et al. (2010). Capsule endoscopy in examination of esophagus for lesions after radiofrequency catheter ablation: a potential tool to select patients with increased risk of complications. Journal of Cardiovascular Electrophysiology, 21(8), 839–844.PubMed
17.
go back to reference Contreras-Valdes, F. M., Heist, E. K., Danik, S. B., Barrett, C. D., Blendea, D., Brugge, W. R., et al. (2011). Severity of esophageal injury predicts time to healing after radiofrequency catheter ablation for atrial fibrillation. Heart Rhythm, 8(12), 1862–1868.PubMedCrossRef Contreras-Valdes, F. M., Heist, E. K., Danik, S. B., Barrett, C. D., Blendea, D., Brugge, W. R., et al. (2011). Severity of esophageal injury predicts time to healing after radiofrequency catheter ablation for atrial fibrillation. Heart Rhythm, 8(12), 1862–1868.PubMedCrossRef
18.
go back to reference Welch, W. J., & Suhan, J. P. (1985). Morphological study of the mammalian stress response: characterization of changes in cytoplasmic organelles, cytoskeleton, and nucleoli, and appearance of intranuclear actin filaments in rat fibroblasts after heat-shock treatment. The Journal of Cell Biology, 101(4), 1198–1211.PubMedCrossRef Welch, W. J., & Suhan, J. P. (1985). Morphological study of the mammalian stress response: characterization of changes in cytoplasmic organelles, cytoskeleton, and nucleoli, and appearance of intranuclear actin filaments in rat fibroblasts after heat-shock treatment. The Journal of Cell Biology, 101(4), 1198–1211.PubMedCrossRef
19.
go back to reference Dickson, J. A., & Calderwood, S. K. (1979). Effects of hyperglycemia and hyperthermia on the pH, glycolysis, and respiration of the Yoshida sarcoma in vivo. Journal of the National Cancer Institute, 63(6), 1371–1381.PubMed Dickson, J. A., & Calderwood, S. K. (1979). Effects of hyperglycemia and hyperthermia on the pH, glycolysis, and respiration of the Yoshida sarcoma in vivo. Journal of the National Cancer Institute, 63(6), 1371–1381.PubMed
20.
go back to reference Rillig, A., Meyerfeldt, U., Birkemeyer, R., Wiest, S., Sauer, B. M., Staritz, M., et al. (2010). Oesophageal temperature monitoring and incidence of oesophageal lesions after pulmonary vein isolation using a remote robotic navigation system. Europace, 12(5), 655–661.PubMedCrossRef Rillig, A., Meyerfeldt, U., Birkemeyer, R., Wiest, S., Sauer, B. M., Staritz, M., et al. (2010). Oesophageal temperature monitoring and incidence of oesophageal lesions after pulmonary vein isolation using a remote robotic navigation system. Europace, 12(5), 655–661.PubMedCrossRef
21.
go back to reference Leite, L. R., Santos, S. N., Henz, B. D., & Barreto, J. R. (2009). Importance of esophageal temperature monitoring combined with intracardiac echocardiography. Journal of Cardiovascular Electrophysiology, 20(8). Leite, L. R., Santos, S. N., Henz, B. D., & Barreto, J. R. (2009). Importance of esophageal temperature monitoring combined with intracardiac echocardiography. Journal of Cardiovascular Electrophysiology, 20(8).
Metadata
Title
Incidences of esophageal injury during esophageal temperature monitoring: a comparative study of a multi-thermocouple temperature probe and a deflectable temperature probe in atrial fibrillation ablation
Authors
Taishi Kuwahara
Atsushi Takahashi
Yoshihide Takahashi
Kenji Okubo
Katsumasa Takagi
Tadashi Fujino
Shigeki Kusa
Masateru Takigawa
Yuji Watari
Kazuya Yamao
Emiko Nakashima
Naohiko Kawaguchi
Hiroyuki Hikita
Akira Sato
Kazutaka Aonuma
Publication date
01-04-2014
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 3/2014
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-013-9868-5

Other articles of this Issue 3/2014

Journal of Interventional Cardiac Electrophysiology 3/2014 Go to the issue