Key result
A five-sensor esophageal thermal monitoring catheter (ETMC5) resulted in a comparable incidence of esophageal thermal lesions compared to a three-sensor catheter (5.8% vs 7.4%; p=1.0).
Why the study?
Esophageal thermal lesion is a complication of radiofrequency ablation for atrial fibrillation, motivating a prospective comparison of five- and three-sensor esophageal thermal monitoring catheters and evaluation of predictors.
Does a five-sensor esophageal thermal monitoring catheter reduce esophageal thermal lesions compared to a three-sensor catheter in patients undergoing first radiofrequency ablation for atrial fibrillation?
RCT (n=106)
Does a five-sensor esophageal thermal monitoring catheter reduce esophageal thermal lesions compared to a three-sensor catheter in patients undergoing first radiofrequency ablation for atrial fibrillation?
Absolute Event Rate: 5.8% vs 7.4%
p-value: p=1.0
A five-sensor esophageal thermal monitoring catheter does not significantly reduce the incidence of esophageal thermal lesions compared to a three-sensor catheter during atrial fibrillation ablation, but it reduces fluoroscopy time and the need for catheter repositioning.
Five-sensor monitoring does not reduce esophageal lesions versus three-sensor; confirms no incremental safety benefit during AF ablation.
BACKGROUND: Esophageal thermal lesion (ETL) is a complication of radiofrequency ablation for atrial fibrillation (RFAF). To prospectively compare the incidence of ETL, we used two linear, five- and three-sensor esophageal thermal monitoring catheters (ETMC5 and ETMC3). We also evaluated the predictors of ETL. METHODS: Patients receiving their first RFAF (n = 106) were randomized into two groups, ETMC5 (n = 52) and ETMC3 (n = 54). Ablation was followed by esophagogastroduodenoscopy within 3 days. RESULTS: Esophageal thermal lesion was detected in 7/106 (6.6%) patients (ETMC5: 3/52 [5.8%] vs. ETMC3: 4/54 [7.4%]; p = 1.0). The maximum temperature and number of measurements > 39.0°C did not differ between the groups (ETMC5: 40.5°C and 5.4 vs. ETMC3: 40.6°C and 4.9; p = .83 and p = .58, respectively). In ETMC5 group, the catheter had to be moved significantly less often (0.12 vs. 0.42; p = .0014) and fluoroscopy time was significantly shorter (79.2 min vs. 101.7 min; p = .0038) compared with ECMC3 group. The total number of ablations in ETMC5 group was significantly greater (50.2 vs. 37.7; p = .030) and ablation time was significantly longer (52.1 min vs. 40.1 min; p = .0039). Only body mass index (BMI) was significantly different between patients with and without ETL (21.4 ± 2.5 vs. 24.3 ± 3.4; p = .022). CONCLUSIONS: The incidence of ETL was comparable between ETMC5 and ETMC3 groups; however, fluoroscopy time, total ablation time, and total number of ablations differed significantly. Lower BMI may increase the risk of developing ETL.
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Arai et al. (2022) conducted an RCT in Atrial fibrillation (n=106). Five-sensor esophageal thermal monitoring catheter (ETMC5) vs. Three-sensor esophageal thermal monitoring catheter (ETMC3) was evaluated on Incidence of esophageal thermal lesion (ETL) (p=1.0). A five-sensor esophageal thermal monitoring catheter (ETMC5) resulted in a comparable incidence of esophageal thermal lesions compared to a three-sensor catheter (5.8% vs 7.4%; p=1.0).
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