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Editorials

Limitations of Esophageal Temperature-Monitoring to Prevent Esophageal Injury During Atrial Fibrillation Ablation

Hiroshi Nakagawa, MD, PhD; Kenneth A. Seres, MD and Warren M. Jackman, MD

From the Cardiac Arrhythmia Research Institute/Heart Rhythm Institute, and Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma

Correspondence to Hiroshi Nakagawa, MD, PhD, Cardiac Arrhythmia Research Institute/Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive (TUH-6E 103), Oklahoma City, Oklahoma 73104. E-mail hiroshi-nakagawa@ouhsc.edu

Key Words: editorial • catheter ablation • radiofrequency • atrial fibrillation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A number of complications have been associated with ablation of atrial fibrillation (AF), including arterial thrombo-embolism, pulmonary vein stenosis, phrenic nerve injury, and pericardial tamponade.^1–4 Esophageal injury, manifested as esophageal perforation or left atrial-esophageal fistula, has been reported after catheter or surgical ablation of AF using radiofrequency (RF) current^5–8 and catheter ablation using high-intensity focused ultrasound (HIFU).⁹ Left atrial-esophageal fistula usually is associated with a very high morbidity and mortality, including air embolism and sepsis.

Article see p 162

Esophageal injury during RF ablation in the left atrium is thought to be thermal injury.^10–12 In this issue of Circulation: Arrhythmia and Electrophysiology, Singh et al¹³ sought to determine whether the risk of esophageal injury would be reduced by measuring the luminal esophageal temperature (LET) during ablation and maintaining the LET below 38.5°C. The LET was measured using a 9Fr flexible temperature probe (with a single thermocouple) in the esophagus. The temperature probe was maneuvered in cranial-caudal direction to position the thermocouple close to the ablation catheter tip in the left atrium.

We agree in principal with the authors’ conclusion that esophageal temperature-monitoring may reduce the risk of esophageal injury during AF ablation. An esophageal ulcer was observed by endoscopy 1 to 3 days postablation in 4 of 67 (6%) patients with LET-monitoring (and discontinuing RF application at LET 38.5°C) compared to 5 of 14 (36%) patients without LET-monitoring. Importantly, in patients with LET-monitoring, this study showed no significant difference between patients with and without an esophageal ulcer and the . . . [Full Text of this Article]

Related Article

Esophageal Injury and Temperature Monitoring During Atrial Fibrillation Ablation

Sheldon M. Singh, Andre d'Avila, Shephal K. Doshi, William R. Brugge, Rudolph A. Bedford, Theofanie Mela, Jeremy N. Ruskin, and Vivek Y. Reddy
Circ Arrhythm Electrophysiol 2008 1: 162-168. [Abstract] [Full Text] [PDF]