Key result
Esophageal temperature during HPSD ablation does not correlate with injury, unlike shorter LA-esophagus distance.
Why the study?
Esophageal injury remains a concern during pulmonary vein isolation using high-power short-duration ablation, and whether high esophageal temperature correlates with endoscopy findings needed investigation.
Does esophageal temperature monitoring predict esophageal injury in patients undergoing high-power short-duration pulmonary vein isolation?
Observational (n=43)
No
Does esophageal temperature monitoring predict esophageal injury in patients undergoing high-power short-duration pulmonary vein isolation?
Absolute Event Rate: 43.9% vs 42.5%
p-value: p=.17
During high-power short-duration pulmonary vein isolation, esophageal injury correlates with the anatomical proximity of the esophagus to the left atrium rather than peak esophageal temperature.
Esophageal temperature monitoring may not predict injury during HPSD ablation; hypothesis-generating for anatomy-based strategies in observational data.
Background Esophageal injury (EI) remains a concern when performing pulmonary vein isolation (PVI) using the high-power short-duration (HPSD) technique. Objective We aim to indicate that high esophageal temperature during HPSD PVI does not correlate with positive esophageal endoscopy (EGD) findings. Methods A retrospective observational study was performed on 43 patients undergoing PVI using HPSD (50 W for 6–7 seconds per lesion) at Tulane Medical Center from July 2020 to January 2021. Esophageal temperature was monitored throughout the procedure using a temperature probe and patients underwent EGD the following day. Small ulcers, nonbleeding erosions, erythema, and/or esophagitis were considered positive EGD findings. Results Mean age was 64.9 years; 46.5% of the patients were female. Eleven patients had positive EGD findings (group 1) and 32 patients had normal EGD (group 2). There was no statistical difference in mean esophageal peak temperature between group 1 and group 2 (43.9°C ± 2.9°C and 42.5°C ± 2.3°C, respectively, P = .17). There was no association between positive EGD results and esophageal temperature during PVI. Mean baseline esophageal temperature was similar in both groups (36.1°C, P = .78). Average contact force ( P = .53), ablation time ( P = .67), age ( P = .3096), sex ( P = .4), body mass index ( P = .14), and other comorbidities did not correlate with positive endoscopy results. We found positive correlation between the distance of the left atrium (LA) to esophagus and positive EGD ( P = .0001). Conclusion EI during HPSD PVI does not correlate to esophageal temperature changes during ablation. However, esophageal injury does correlate to a shorter proximity of the esophagus to the LA.
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Ayoub et al. (2021) conducted an observational in Atrial fibrillation (n=43). Esophageal temperature was evaluated on Mean esophageal peak temperature in patients with vs without positive EGD findings (p=.17). Esophageal temperature during HPSD ablation did not differ between patients with and without esophageal injury (43.9°C vs 42.5°C, P=0.17), though injury correlated with shorter LA-esophagus distance.
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