Esophageal Temperature Monitoring during Atrial Fibrillation Ablation: A Randomized Study

Area of Science:

• Electrophysiology
• Cardiology
• Medical Device Technology

Background:

• Atrial fibrillation (AF) ablation via pulmonary vein isolation (PVI) carries a risk of esophageal thermal injury (ETI).
• ETI can lead to severe complications, necessitating effective preventative strategies.

Purpose of the Study:

• To evaluate three luminal esophageal temperature (LET) monitoring strategies for their efficacy in preventing ETI during PVI.
• To compare outcomes between no monitoring, single-sensor probe (SSP) monitoring, and multisensor probe (MSP) monitoring.

Main Methods:

• A randomized trial involving 60 patients undergoing PVI for AF, divided into three groups (n=20 each): no LET monitoring, SSP monitoring, and MSP monitoring.
• Ablation power was fixed in the no-monitoring group and titrated based on LET in the SSP and MSP groups, with a 37.5°C cutoff.
• Esophagogastroduodenoscopy was performed post-procedure to assess for ETI.

Main Results:

• No esophageal thermal injury (ETI) occurred in the multisensor probe (MSP) group.
• ETI developed in 5 patients without monitoring and 6 patients with single-sensor probe (SSP) monitoring (p=0.006).
• Higher esophageal temperatures were recorded with MSP monitoring (37.9°C vs. 38.45°C with SSP), without affecting procedure or ablation times.

Conclusions:

• Luminal esophageal temperature (LET) monitoring using a multisensor probe (MSP) significantly reduces ETI incidence during pulmonary vein isolation (PVI).
• Advanced LET monitoring, particularly with MSP, enhances patient safety during AF ablation.
• This strategy improves safety without compromising procedural efficiency.