Minimizing Esophageal Heating During Radiofrequency Catheter Ablation

Area of Science:

• Electrophysiology
• Cardiac Ablation Technology
• Medical Device Safety

Background:

• Atrio-esophageal fistula is a rare but severe complication of thermal esophageal injury during pulmonary vein isolation (PVI).
• Strategies to mitigate esophageal thermal injury include modifying ablation energy delivery and using esophageal temperature probes (ETPs).
• The study investigates the impact of return electrode location, ETP insulation, and high-power short-duration (HPSD) ablation on esophageal temperature.

Purpose of the Study:

• To compare the effects of return electrode location, ETP insulation, and HPSD ablation on esophageal temperature.
• To evaluate the influence of these factors on ETP temperature measurement and thermal lesion dimensions.
• To identify strategies for reducing esophageal thermal injury during radiofrequency ablation.

Main Methods:

• A myocardial phantom gel model with thermochromic material simulated the atrio-esophageal environment.
• Irrigated ablations were performed using low-power long duration (LPLD) and HPSD settings.
• Variations included return electrode position and ETP insulation; temperatures and lesion dimensions were recorded.

Main Results:

• Distant return electrode placement significantly decreased peak esophageal temperature (T_Peak) for both LPLD and HPSD ablations.
• ETP insulation also reduced T_Peak across both ablation settings.
• HPSD ablation consistently produced lower mean T_Peak compared to LPLD, irrespective of electrode placement or ETP insulation.

Conclusions:

• HPSD settings, ETP insulation, and distant return electrode placement effectively minimize esophageal heating.
• These combined strategies show promise in reducing the risk of thermal esophageal injury during radiofrequency ablation procedures.
• Further clinical validation may confirm the efficacy of these protective measures.