Intraluminal Esophageal Temperature Monitoring Using the Circa S-Cath™ Temperature Probe to Guide Left Atrial Ablation in Patients with Atrial Fibrillation

Overview

Journal J Atr Fibrillation

Date 2021 Dec 24

PMID 34950319

Citations 1

Authors

Sapan Bhuta

Jonathan Hsu

Kurt S Hoffmayer

Michael Mello

Thomas Savides

Malek Bashti

Jessica Hunter

Kathryn Lewis

Gregory K Feld

Affiliations

Soon will be listed here.

Abstract

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-six patients, enrolled prospectively, underwent circumferential or segmental pulmonary vein isolation for treatment of AF. A maximum ablation electrode temperature 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 39º C. 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 as likely traumatic or thermally related. Of the 36 patients 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 was 44.5±20.5 grams where measured. Only 1 patient (<3%) had an esophageal lesion that could potentially represent thermal injury and 4 patients (11.1%) had minor traumatic mechanical injury.

Conclusions: 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.

Citing Articles

Esophageal Protection and Temperature Monitoring Using the Circa S-Cath™ Temperature Probe during Epicardial Radiofrequency Ablation of the Pulmonary Veins and Posterior Left Atrium.

Kronenberger R, Parise O, Van Loo I, Gelsomino S, Welch A, de Asmundis C J Clin Med. 2022; 11(23).

PMID: 36498514 PMC: 9741413. DOI: 10.3390/jcm11236939.

References

Schmidt M, Nolker G, Marschang H, Gutleben K, Schibgilla V, Rittger H . Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation. Europace. 2008; 10(2):205-9. DOI: 10.1093/europace/eun001. View

Good E, Oral H, Lemola K, Han J, Tamirisa K, Igic P . Movement of the esophagus during left atrial catheter ablation for atrial fibrillation. J Am Coll Cardiol. 2005; 46(11):2107-10. DOI: 10.1016/j.jacc.2005.08.042. View

Ghia K, Chugh A, Good E, Pelosi F, Jongnarangsin K, Bogun F . A nationwide survey on the prevalence of atrioesophageal fistula after left atrial radiofrequency catheter ablation. J Interv Card Electrophysiol. 2008; 24(1):33-6. DOI: 10.1007/s10840-008-9307-1. View

Feld G, Tate C, Hsu J . Esophageal temperature monitoring during AF ablation: multi-sensor or single-sensor probe?. J Cardiovasc Electrophysiol. 2013; 24(12):E24. DOI: 10.1111/jce.12305. View

Tsuchiya T, Ashikaga K, Nakagawa S, Hayashida K, Kugimiya H . Atrial fibrillation ablation with esophageal cooling with a cooled water-irrigated intraesophageal balloon: a pilot study. J Cardiovasc Electrophysiol. 2007; 18(2):145-50. DOI: 10.1111/j.1540-8167.2006.00693.x. View

Halm U, Gaspar T, Zachaus M, Sack S, Arya A, Piorkowski C . Thermal esophageal lesions after radiofrequency catheter ablation of left atrial arrhythmias. Am J Gastroenterol. 2009; 105(3):551-6. DOI: 10.1038/ajg.2009.625. View

Cummings J, Schweikert R, Saliba W, Burkhardt J, Brachmann J, Gunther J . Assessment of temperature, proximity, and course of the esophagus during radiofrequency ablation within the left atrium. Circulation. 2005; 112(4):459-64. DOI: 10.1161/CIRCULATIONAHA.104.509612. View

Yamasaki H, Tada H, Sekiguchi Y, Igarashi M, Arimoto T, Machino T . Prevalence and characteristics of asymptomatic excessive transmural injury after radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm. 2011; 8(6):826-32. DOI: 10.1016/j.hrthm.2011.01.045. View

Deneke T, Bunz K, Bastian A, Pasler M, Anders H, Lehmann R . Utility of esophageal temperature monitoring during pulmonary vein isolation for atrial fibrillation using duty-cycled phased radiofrequency ablation. J Cardiovasc Electrophysiol. 2010; 22(3):255-61. DOI: 10.1111/j.1540-8167.2010.01916.x. View

10.

Perez J, dAvila A, Aryana A, Berjano E . Electrical and thermal effects of esophageal temperature probes on radiofrequency catheter ablation of atrial fibrillation: results from a computational modeling study. J Cardiovasc Electrophysiol. 2015; 26(5):556-64. DOI: 10.1111/jce.12630. View

11.

Cummings J, Barrett C, Litwak K, Di Biase L, Chowdhury P, Oh S . Esophageal luminal temperature measurement underestimates esophageal tissue temperature during radiofrequency ablation within the canine left atrium: comparison between 8 mm tip and open irrigation catheters. J Cardiovasc Electrophysiol. 2008; 19(6):641-4. DOI: 10.1111/j.1540-8167.2008.01130.x. View

12.

Redfearn D, Trim G, Skanes A, Petrellis B, Krahn A, Yee R . Esophageal temperature monitoring during radiofrequency ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2005; 16(6):589-93. DOI: 10.1111/j.1540-8167.2005.40825.x. View

13.

Zellerhoff S, Ullerich H, Lenze F, Meister T, Wasmer K, Monnig G . Damage to the esophagus after atrial fibrillation ablation: Just the tip of the iceberg? High prevalence of mediastinal changes diagnosed by endosonography. Circ Arrhythm Electrophysiol. 2010; 3(2):155-9. DOI: 10.1161/CIRCEP.109.915918. View

14.

Calkins H, Kuck K, Cappato R, Brugada J, Camm A, Chen S . 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial.... Heart Rhythm. 2012; 9(4):632-696.e21. DOI: 10.1016/j.hrthm.2011.12.016. View

15.

Scanavacca M, dAvila A, Parga J, Sosa E . Left atrial-esophageal fistula following radiofrequency catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2004; 15(8):960-2. DOI: 10.1046/j.1540-8167.2004.04083.x. View

16.

Carroll B, Contreras-Valdes F, Heist E, Barrett C, Danik S, Ruskin J . Multi-sensor esophageal temperature probe used during radiofrequency ablation for atrial fibrillation is associated with increased intraluminal temperature detection and increased risk of esophageal injury compared to single-sensor probe. J Cardiovasc Electrophysiol. 2013; 24(9):958-64. DOI: 10.1111/jce.12180. View

17.

Lemola K, Sneider M, Desjardins B, Case I, Han J, Good E . Computed tomographic analysis of the anatomy of the left atrium and the esophagus: implications for left atrial catheter ablation. Circulation. 2004; 110(24):3655-60. DOI: 10.1161/01.CIR.0000149714.31471.FD. View

18.

Koruth J, Reddy V, Miller M, Patel K, Coffey J, Fischer A . Mechanical esophageal displacement during catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2011; 23(2):147-54. DOI: 10.1111/j.1540-8167.2011.02162.x. View

19.

Tilz R, Chun K, Metzner A, Burchard A, Wissner E, Koektuerk B . Unexpected high incidence of esophageal injury following pulmonary vein isolation using robotic navigation. J Cardiovasc Electrophysiol. 2010; 21(8):853-8. DOI: 10.1111/j.1540-8167.2010.01742.x. View

20.

Martinek M, Bencsik G, Aichinger J, Hassanein S, Schoefl R, Kuchinka P . Esophageal damage during radiofrequency ablation of atrial fibrillation: impact of energy settings, lesion sets, and esophageal visualization. J Cardiovasc Electrophysiol. 2009; 20(7):726-33. DOI: 10.1111/j.1540-8167.2008.01426.x. View