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Circ Arrhythm Electrophysiol. 2013 Aug;6(4):769-75. doi: 10.1161/CIRCEP.113.000228. Epub 2013 Jun 7.

Increased incidence of esophageal thermal lesions using the second-generation 28-mm cryoballoon.

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1
Departments of Cardiology and Internal Medicine, Asklepios Klinik St. Georg, Hamburg, Germany.

Abstract

BACKGROUND:

Pulmonary vein isolation is an established treatment option for atrial fibrillation. To date, the incidence and quality of ablation-induced esophageal thermal lesions (ETLs) using the recently introduced second-generation cryoballoon (CB, ArcticFront Advance, Medtronic) is unknown.

METHODS AND RESULTS:

In patients with drug-refractory paroxysmal atrial fibrillation or short-standing persistent atrial fibrillation, pulmonary vein (PV) isolation was performed using the second-generation CB. The endoluminal esophageal temperature was monitored via a temperature probe. After PV isolation, esophagogastroduodenoscopy (EGD) was performed to assess the incidence of ETLs. In 50 patients (18 women; age, 61±11 years; left atrial diameter, 43±5 mm), successful CB-based PV isolation was performed. Lowest median balloon temperature and esophageal temperature for the right superior PV were -51°C and 35.8°C, -47°C and 35°C for the right inferior PV, -51°C and 34.4°C for the left superior PV, -48°C and 34.6°C for the left inferior PV, and -54°C and 34.5°C for the left common PV, respectively. EGD performed 2±1 days post ablation demonstrated superficial thermal lesions and thermal ulcerations in 1 of 50 (2%) and 5 of 50 (10%) patients, respectively. In patients with ETLs, during ≥1 freeze cycle the endoluminal esophageal temperature measured <3.0°C. All thermal lesions were in the healing process on repeat EGD 4±2 days after initial endoscopy.

CONCLUSIONS:

Using the second-generation 28-mm CB, ETLs were detected in 6 of 50 (12%) patients. All ETLs were in the healing process on repeat EGD. An esophageal temperature safety cutoff may prove valuable in the prevention of ETLs and requires further evaluation.

KEYWORDS:

ablation; atrial fibrillation; complications

Comment in

PMID:
23748208
DOI:
10.1161/CIRCEP.113.000228
[Indexed for MEDLINE]

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