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. 2024 Jun 27;14(13):1370.
doi: 10.3390/diagnostics14131370.

Cryoballoon-Assisted Pulmonary Vein Isolation and Left Atrial Roof Ablation Using a Simplified Sedation Strategy without Esophageal Temperature Monitoring: No Notable Thermal Esophageal Lesions and Low Arrhythmia Recurrence Rates after 2 Years

Damir Erkapic  1   2 , Konstantinos Roussopoulos  1 , Marko Aleksic  1 , Korkut Sözener  1 , Karel Kostev  3 , Josef Rosenbauer  1 , Samuel Sossalla  2 , Dursun Gündüz  1   2 , Joachim Labenz  4 , Christian Tanislav  5 , Kay Felix Weipert  1   2
Affiliations

Cryoballoon-Assisted Pulmonary Vein Isolation and Left Atrial Roof Ablation Using a Simplified Sedation Strategy without Esophageal Temperature Monitoring: No Notable Thermal Esophageal Lesions and Low Arrhythmia Recurrence Rates after 2 Years

Damir Erkapic et al. Diagnostics (Basel). .

Abstract

Background: Atrial fibrillation (AF) ablation is increasingly effective for managing heart rhythm but poses risks like esophageal fistulas. Minimizing esophageal thermal lesions while simplifying procedures is crucial.

Methods: This prospective study involved 100 consecutive AF patients undergoing cryoballoon ablation with simplified sedation, without esophageal temperature monitoring. Patients with paroxysmal AF (Group A) received pulmonary vein isolation only, while those with persistent AF (Group B) also had left atrial roof ablation. Gastroesophageal endoscopy was performed post-procedure to detect lesions, and cardiological follow-ups were conducted at 3, 12, and 24 months.

Results: The cohort included 69% men, with a median age of 65.5 years. Post-ablation endoscopy was performed in 92 patients; esophageal lesions were found in 1.1% of Group A and none of Group B. GERD was diagnosed in 14% of patients, evenly distributed between groups and not linked to lesion occurrence. Gastric hypomotility was observed in 16% of patients, with no significant difference between groups. At 24 months, arrhythmia-free survival was 88% in Group A and 74% in Group B.

Conclusion: Cryoballoon-assisted pulmonary vein isolation, with or without additional left atrial roof ablation and without esophageal temperature monitoring during a simplified sedation strategy, shows low risk of esophageal thermal injury and effective ablation outcomes.

Keywords: EDEL; LARA; ablation; atrial fibrillation; cryoballoon; esophageal lesion; pulmonary vein isolation; roof line.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flowchart. AF = atrial fibrillation; PVI = pulmonary vein isolation; LARA = left atrial roof ablation.
Figure 2
Figure 2
(A) Left atrial roof ablation (LARA) technique using cryoballoon ablation in RAO 30° view. The borders of the left atrium, pulmonary veins, transseptal puncture site, and overlapping freezes were traced on the examiner monitor using a board marker; (B) 3D representation of LARA in the Voltage MAP (threshold 0.5/0.2 mV) during AF Redo procedure in follow-up using the EnSite Precision Cardiac Mapping System (Abbott). RAO = right anterior oblique; AF = atrial fibrillation.
Figure 3
Figure 3
Endoscopically detected esophageal superficial lesion after PVI only.
Figure 4
Figure 4
Arrhythmia-free survival at mid-term follow-up after PVI only and PVI+LARA using the cryoballoon.
See this image and copyright information in PMC

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