Introduction: Radiofrequency catheter ablation is a common treatment for atrial fibrillation (AF), during which thermal esophageal injury may rarely occur and lead to an atrio-esophageal fistula. Therefore, we studied the utility of the Circa S-Cath™ multi-sensor luminal esophageal temperature (LET) probe to prevent esophageal thermal injury. Methods and Results:Thirty-sixpatients, enrolled prospectively, underwent circumferential or segmental pulmonary vein isolationfor treatment of AF. A maximum ablation electrodetemperature of 42ºC was programmed for automatic power delivery cutoff. In addition, energy delivery was manually discontinued when the maximum LET on any sensor of the probe rose abruptly (i.e. ˃0.2ºC) or exceeded 39ºC. Esophagoscopy was performed immediately after ablation in 18 patients (with the temperature probe still in place) and at approximately 24 hours after ablation in 18 patients. Esophageal lesions were classified aslikely traumatic or thermally related. Of the 36patients enrolled in the study, 21 had persistent and 15 had paroxysmal AF,average LVEF 57±16% and CHA2DS2VASc score 1.6±1.2 (range 0-4). Average maximum LET was 37.8±1.4ºC, power delivery 31.1±8 watts and ablation electrode temperature 36.4±4.1ºC. Average maximum contact force was44.5±20.5 grams where measured. Only 1patient (<3%) had an esophageal lesion that could potentially represent thermal injury and4patients(11.1%) had minor traumatic mechanical injury. Conclusion: LET guided titration of power and duration of energy application, using an insulated multi-sensor esophageal temperature probe, is associated with a low risk of esophageal thermal injury during AF ablation. In only rare cases, LET monitoring resulted in the need to manipulate the esophagus to avoid unacceptable temperature rises, that could not be achieved by adjustment of power and duration of energy application.
Credits: SapanBhuta, Jonathan Hsu, Kurt S. Hoffmayer, Michael Mello , Thomas Savides , Malek Bashti, Jessica Hunter, and Kathryn Lewis, and Gregory K. Feld,