Esophagus-Related Complications During Second-Generation Cryoballoon Ablation-Insight from Simultaneous Esophageal Temperature Monitoring from 2 Esophageal Probes

Abstract

Background: Monitoring luminal esophageal temperatures (LETs) helps predict esophageal thermal lesions (ETLs) after catheter ablation. This study aimed to evaluate esophagus-related complications after second-generation cryoballoon ablation under simultaneous LETs monitoring from 2 esophageal probes.

Methods: Forty consecutive paroxysmal atrial fibrillation patients undergoing second-generation cryoballoon ablation under conscious sedation followed by esophagogastroscopy were prospectively included. Two temperature probes inserted bi-nasally (both non-deflectable in 13, non-deflectable and deflectable in 27 patients) were used for LET monitoring. Pulmonary vein isolation was performed with one 28-mm balloon using single 3-minute freeze techniques.

Results: The lowest LETs significantly correlated between different probes; however, deflectable probe showed significantly lower nadir LETs than non-deflectable probes (14.6 ± 9.2 vs. 20.0 ± 10.6 ℃, P<0.0001). Esophagogastroscopy post-ablation demonstrated ETLs and gastroparesis in 8 (20%) and 7 (17.5%) patients (total 13 [32.5%]), respectively. The optimal cutoff for the lowest LET measured on any probe for predicting no ETLs was 12.8 ℃ (sensitivity 78.1%, specificity 100%). When using deflectable and non-deflectable catheters, the optimal cutoff point for the lowest LET for predicting no ETLs was 11.4 ℃ (sensitivity 70.0%, specificity 100%) and 19.4 ℃ (sensitivity 63.6%, specificity 100%), respectively. No ETLs were detected in 12 (30%) patients with the esophagus located between the left atrium and spine. All esophagus-related complications were asymptomatic and had healed on repeat esophagogastroscopy by a mean of 53 ± 25 days after the procedure.

Conclusions: The lowest LET highly depended on the temperature probe location. However, if a different cutoff value was applied, LET monitoring, regardless of the probe type, and anatomical information might help predict ETLs during second-generation cryoballoon ablation.

Keywords: atrial fibrillation; cryoballoon; esophageal injury; gastroparesis; pulmonary vein isolation.