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January 22, 2026Annals of Noninvasive Electrocardiology0 citationsOpen Access

Impact of Esophageal Temperature Monitoring on Esophageal Injury in PVI: A Systematic Review and Meta‐Analysis

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SMSaad ManzoorMKMounika KotteJMJahanzeb Malik

Key Result

Esophageal temperature monitoring significantly reduced the risk of endoscopically detected esophageal lesions compared with no monitoring (OR 0.57; 95% CI 0.39-0.85).

Key Points

  • Evaluate the impact of esophageal temperature monitoring on esophageal injury during cryoballoon ablation for atrial fibrillation.
  • Conducted a systematic search for randomized controlled and observational studies.
  • Compared CBA procedures with and without esophageal temperature monitoring.
  • Extracted data on patient characteristics, procedural details, and esophageal outcomes.
  • ETM significantly reduced the risk of endoscopically detected esophageal lesions (EDEL) with a pooled odds ratio of 0.57.
  • Severe ulceration and symptomatic esophageal thermal injury were infrequent.
  • No cases of atrioesophageal fistula were reported.

Study Design

Type

Meta-Analysis (n=269)

Structured PICO

Does esophageal temperature monitoring reduce the incidence of esophageal injury in patients undergoing cryoballoon ablation for atrial fibrillation?

P
Population
269 patients from 4 studies undergoing cryoballoon ablation for atrial fibrillation.
I
Intervention
Esophageal temperature monitoring (ETM) during cryoballoon ablation
C
Comparator
No esophageal temperature monitoring during cryoballoon ablation
O
Outcome
Incidence of endoscopically detected esophageal lesions (EDEL)safety

Esophageal temperature monitoring during cryoballoon ablation for atrial fibrillation significantly reduces the risk of endoscopically detected esophageal lesions and should be considered a routine safety measure.

Main Result

Odds Ratio: 0.57 (95% CI 0.39–0.85)

Abstract

ABSTRACT Objective This meta‐analysis aimed to evaluate the impact of esophageal temperature monitoring (ETM) on the incidence of esophageal injury during cryoballoon ablation (CBA) for atrial fibrillation (AF). Methods A systematic search identified randomized controlled and observational studies comparing CBA procedures performed with versus without ETM. Data on study design, patient characteristics, procedural details, and esophageal outcomes were extracted. The primary endpoint was the incidence of endoscopically detected esophageal lesions (EDEL). Secondary outcomes included severe ulceration, symptomatic esophageal thermal injury (ETI), and atrioesophageal fistula (AEF). Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random‐effects model. Risk of bias was assessed according to Cochrane guidelines, and publication bias was evaluated with funnel plots. Results Four studies comprising 269 patients were included. ETM significantly reduced the risk of EDEL compared with no ETM (pooled OR 0.57, 95% CI 0.39–0.85), with low to moderate heterogeneity. Subgroup analyses confirmed consistent benefits across randomized and observational designs. Severe esophageal ulceration and symptomatic ETI were infrequent, and no AEF cases were reported. Funnel plot analysis indicated no major publication bias. Conclusion ETM significantly lowers the incidence of esophageal injury during CBA and should be considered a routine safety measure to improve procedural outcomes.

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Cite This Study

Manzoor et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=269). Esophageal temperature monitoring (ETM) vs. No ETM was evaluated on Incidence of endoscopically detected esophageal lesions (EDEL) (OR 0.57, 95% CI 0.39-0.85). Esophageal temperature monitoring significantly reduced the risk of endoscopically detected esophageal lesions compared with no monitoring (OR 0.57; 95% CI 0.39-0.85).

synapsesocial.com/papers/6971bfdff17b5dc6da021f41https://doi.org/10.1111/anec.70156
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