Published Online
on June 9, 2008

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Original Article

Esophageal injury and temperature monitoring during atrial fibrillation ablation

Sheldon M. Singh¹, Andre D'Avila^1,5, Shephal K. Doshi², William R. Brugge³, Rudolph A. Bedford⁴, Theofanie Mela¹, Jeremy N. Ruskin¹ and Vivek Y. Reddy¹

¹ Cardiac Arrhythmia Service, Massachusetts General Hospital;
² Cardiac Electrophysiology and Pacing Service, St. John's Health Centre;
³ Gastrointestinal Endoscopy Unit, Massachusetts General Hospital;
⁴ Southern California Medical Gastroenterology Group

Correspondence: ⁵ E-mail: smsingh{at}partners.org

Background—It is common practice to empirically limit the radiofrequency (RF) power when ablating the posterior left atrium (LA) during atrial fibrillation (AF) ablation to avoid thermal injury to the esophagus. The objective of this study was to determine whether RF energy delivery limited by luminal esophageal temperature (LET) monitoring is associated with a reduction in esophageal injury compared to a strategy of RF power limitation alone.

Methods and Results—Eighty-one consecutive patients undergoing AF ablation followed by esophageal endoscopy (EGD) were included in this observational study. All patients underwent extra-ostial electrical PV isolation using an electro-anatomical mapping system and irrigated RF ablation. All RF applications on the posterior LA were limited to 35 Watts. A commercially available, single-thermocouple esophageal probe was used to monitor LET in a subset of patients (n=67). In these cases, applications were promptly interrupted when LET was 38.5°C; further applications were performed at reduced power to obtain a LET <38.5°C. EGD was performed 1-3 days post-procedure. Ablation-related esophageal ulcerations were identified in 9/81 (11%) patients. All patients were asymptomatic. Of these 81 patients, LET monitoring during ablation occurred in 67 (83%) of patients. Esophageal injury was observed more frequently (36% vs. 6%, p< 0.006) in the group without LET monitoring.

Conclusions—These data suggest that LET monitoring may be associated with a reduction in esophageal injury compared to power limitation alone.

Key Words: catheter ablation • complications • atrial fibrillation