Impact of Esophageal Temperature Monitoring on Esophageal Injury in PVI: A Systematic Review and Meta-Analysis

This meta-analysis aimed to evaluate the impact of esophageal temperature monitoring (ETM) on the incidence of esophageal injury during cryoballoon ablation (CBA) for atrial fibrillation (AF).

A systematic search identified randomized controlled and observational studies comparing CBA procedures performed with versus without ETM. Data on study design, patient characteristics, procedural details, and esophageal outcomes were extracted. The primary endpoint was the incidence of endoscopically detected esophageal lesions (EDEL). Secondary outcomes included severe ulceration, symptomatic esophageal thermal injury (ETI), and atrioesophageal fistula (AEF). Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Risk of bias was assessed according to Cochrane guidelines, and publication bias was evaluated with funnel plots.

Four studies comprising 269 patients were included. ETM significantly reduced the risk of EDEL compared with no ETM (pooled OR 0.57, 95% CI 0.39-0.85), with low to moderate heterogeneity. Subgroup analyses confirmed consistent benefits across randomized and observational designs. Severe esophageal ulceration and symptomatic ETI were infrequent, and no AEF cases were reported. Funnel plot analysis indicated no major publication bias.

ETM significantly lowers the incidence of esophageal injury during CBA and should be considered a routine safety measure to improve procedural outcomes.