Key result
Immediate discontinuation of ablation at 39°C during pulmonary vein isolation significantly decreased the incidence of esophageal thermal lesions compared to physician-determined timing (P=0.0254).
Why the study?
Does immediate discontinuation of ablation at 39 °C reduce the incidence of esophageal thermal lesions in patients undergoing atrial fibrillation radiofrequency ablation?
Cohort (n=82)
Does immediate discontinuation of ablation at 39 °C reduce the incidence of esophageal thermal lesions in patients undergoing atrial fibrillation radiofrequency ablation?
p-value: p=0.0254
Immediate discontinuation of radiofrequency ablation when esophageal temperature reaches 39 °C significantly reduces the incidence of esophageal thermal lesions.
May support temperature-guided limits to reduce esophageal injury; hypothesis-generating from cohort data, needing RCTs before practice change.
BACKGROUND: Left atrial-esophageal fistulas (LAEFs) are serious complications with high mortality after atrial fibrillation radiofrequency ablation (AFRA). Decreasing the incidence of esophageal thermal lesions (EsoTLs) that may lead to LAEFs is important. The aim of this study was to suppress EsoTL development and determine the appropriate alarm setting for a temperature-monitoring probe by using steerable sheath (STS) methods. METHODS: We enrolled 82 consecutive patients (mean, 61.9±11.7 years; 75.6% men) who underwent AFRA, including pulmonary vein isolation for symptomatic, drug-refractory atrial fibrillation with esophageal temperature monitoring by using STS between January 2011 and April 2014. All patients underwent upper gastrointestinal endoscopy (UGE) 1-3 days after AFRA. The timing of ablation discontinuation in the first 17 patients was determined by each physician during AFRA (only monitoring group, OM). In the next 65 patients, physicians were to immediately discontinue ablation when an alarm set at 39 °C went off (instruction group, INS). We compared two groups with respect to the incidence of EsoTLs. RESULTS: =0.0254). EsoTL did not occur at maximal temperature less than 39 °C, measured by using esophageal temperature-monitoring probe. CONCLUSIONS: Immediate discontinuation of ablation during pulmonary vein isolation remarkably decreased the incidence of EsoTLs, even when using STS.
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Watanabe et al. (2016) conducted a cohort in symptomatic, drug-refractory atrial fibrillation (n=82). Immediate discontinuation of ablation at 39 °C alarm vs. Ablation discontinuation timing determined by physician discretion was evaluated on Incidence of esophageal thermal lesions (EsoTLs) (p=0.0254). Immediate discontinuation of ablation at 39°C during pulmonary vein isolation significantly decreased the incidence of esophageal thermal lesions compared to physician-determined timing (P=0.0254).
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