Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes

Background Endoscopically detected esophageal lesions (EDELs) have been identified in apparently asymptomatic patients after catheter ablation of atrial fibrillation (AF). The use of esophageal probes to monitor luminal esophageal temperature (LET) during catheter ablation to protect esophageal dama...

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Veröffentlicht in:Heart rhythm 2015-07, Vol.12 (7), p.1464-1469
Hauptverfasser: Müller, Patrick, MD, Dietrich, Johannes-Wolfgang, MD, Halbfass, Philipp, MD, Abouarab, Aly, Fochler, Franziska, Szöllösi, Atilla, Nentwich, Karin, MD, Roos, Markus, MD, Krug, Joachim, MD, Schade, Anja, MD, Mügge, Andreas, MD, Deneke, Thomas, MD
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container_end_page 1469
container_issue 7
container_start_page 1464
container_title Heart rhythm
container_volume 12
creator Müller, Patrick, MD
Dietrich, Johannes-Wolfgang, MD
Halbfass, Philipp, MD
Abouarab, Aly
Fochler, Franziska
Szöllösi, Atilla
Nentwich, Karin, MD
Roos, Markus, MD
Krug, Joachim, MD
Schade, Anja, MD
Mügge, Andreas, MD
Deneke, Thomas, MD
description Background Endoscopically detected esophageal lesions (EDELs) have been identified in apparently asymptomatic patients after catheter ablation of atrial fibrillation (AF). The use of esophageal probes to monitor luminal esophageal temperature (LET) during catheter ablation to protect esophageal damage is currently controversial. Objective The purpose of this study was to investigate the impact of the use of esophageal temperature probes during AF catheter ablation on the incidence of EDELs. Methods Eighty consecutive patients (mean age 63.8 ± 11.36 years; 68.8% men) with symptomatic, drug-refractory paroxysmal (n = 52, 65%) or persistent AF who underwent left atrial radiofrequency catheter ablation were prospectively enrolled. Posterior wall ablation was power limited (≤25 W). In the first 40 patients, LET was monitored continuously (group A), whereas no esophageal temperature probe was used in group B (n = 40 patients). Assessment of EDEL was performed by endoscopy within 2 days after radiofrequency catheter ablation. Results Overall, 13 patients (16%) developed EDELs after AF ablation. The incidence of EDELs was significantly higher in group A than group B (30% vs 2.5%, P < .01). Within group A, patients who developed EDEL had higher maximal LET during AF ablation than patients without EDEL (40.97 ± 0.92°C vs 40.14 ± 1.1°C, P = .02). Multivariable logistic regression analysis revealed the use of an esophageal temperature probe as the only independent predictor for the development of EDEL (odds ratio 16.7, P < .01). Conclusion The use of esophageal temperature probes in the setting of AF catheter ablation per se appears to be a risk factor for the development of EDEL.
doi_str_mv 10.1016/j.hrthm.2015.04.005
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The use of esophageal probes to monitor luminal esophageal temperature (LET) during catheter ablation to protect esophageal damage is currently controversial. Objective The purpose of this study was to investigate the impact of the use of esophageal temperature probes during AF catheter ablation on the incidence of EDELs. Methods Eighty consecutive patients (mean age 63.8 ± 11.36 years; 68.8% men) with symptomatic, drug-refractory paroxysmal (n = 52, 65%) or persistent AF who underwent left atrial radiofrequency catheter ablation were prospectively enrolled. Posterior wall ablation was power limited (≤25 W). In the first 40 patients, LET was monitored continuously (group A), whereas no esophageal temperature probe was used in group B (n = 40 patients). Assessment of EDEL was performed by endoscopy within 2 days after radiofrequency catheter ablation. Results Overall, 13 patients (16%) developed EDELs after AF ablation. The incidence of EDELs was significantly higher in group A than group B (30% vs 2.5%, P &lt; .01). Within group A, patients who developed EDEL had higher maximal LET during AF ablation than patients without EDEL (40.97 ± 0.92°C vs 40.14 ± 1.1°C, P = .02). Multivariable logistic regression analysis revealed the use of an esophageal temperature probe as the only independent predictor for the development of EDEL (odds ratio 16.7, P &lt; .01). Conclusion The use of esophageal temperature probes in the setting of AF catheter ablation per se appears to be a risk factor for the development of EDEL.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2015.04.005</identifier><identifier>PMID: 25847474</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Atrial fibrillation ; Atrial Fibrillation - surgery ; Atrioesophageal fistula ; Body Mass Index ; Cardiovascular ; Catheter ablation ; Catheter Ablation - adverse effects ; Catheter Ablation - methods ; Esophageal Fistula - diagnosis ; Esophageal Fistula - epidemiology ; Esophageal Fistula - etiology ; Esophageal lesion ; Esophageal temperature monitoring ; Esophagoscopy - methods ; Esophagus - injuries ; Female ; Germany ; Heart Atria - pathology ; Heart Atria - surgery ; Hot Temperature - adverse effects ; Humans ; Incidence ; Male ; Middle Aged ; Monitoring, Intraoperative - adverse effects ; Monitoring, Intraoperative - methods ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Postoperative Complications - prevention &amp; control ; Risk Assessment ; Risk Factors ; Thermometry - adverse effects ; Thermometry - methods</subject><ispartof>Heart rhythm, 2015-07, Vol.12 (7), p.1464-1469</ispartof><rights>Heart Rhythm Society</rights><rights>2015 Heart Rhythm Society</rights><rights>Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. 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The use of esophageal probes to monitor luminal esophageal temperature (LET) during catheter ablation to protect esophageal damage is currently controversial. Objective The purpose of this study was to investigate the impact of the use of esophageal temperature probes during AF catheter ablation on the incidence of EDELs. Methods Eighty consecutive patients (mean age 63.8 ± 11.36 years; 68.8% men) with symptomatic, drug-refractory paroxysmal (n = 52, 65%) or persistent AF who underwent left atrial radiofrequency catheter ablation were prospectively enrolled. Posterior wall ablation was power limited (≤25 W). In the first 40 patients, LET was monitored continuously (group A), whereas no esophageal temperature probe was used in group B (n = 40 patients). Assessment of EDEL was performed by endoscopy within 2 days after radiofrequency catheter ablation. Results Overall, 13 patients (16%) developed EDELs after AF ablation. The incidence of EDELs was significantly higher in group A than group B (30% vs 2.5%, P &lt; .01). Within group A, patients who developed EDEL had higher maximal LET during AF ablation than patients without EDEL (40.97 ± 0.92°C vs 40.14 ± 1.1°C, P = .02). Multivariable logistic regression analysis revealed the use of an esophageal temperature probe as the only independent predictor for the development of EDEL (odds ratio 16.7, P &lt; .01). 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Dietrich, Johannes-Wolfgang, MD ; Halbfass, Philipp, MD ; Abouarab, Aly ; Fochler, Franziska ; Szöllösi, Atilla ; Nentwich, Karin, MD ; Roos, Markus, MD ; Krug, Joachim, MD ; Schade, Anja, MD ; Mügge, Andreas, MD ; Deneke, Thomas, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c484t-97172b2da3b330bad25333e5cd3a5d90211b52a0415e4b3a865c613325fee91d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Atrial fibrillation</topic><topic>Atrial Fibrillation - surgery</topic><topic>Atrioesophageal fistula</topic><topic>Body Mass Index</topic><topic>Cardiovascular</topic><topic>Catheter ablation</topic><topic>Catheter Ablation - adverse effects</topic><topic>Catheter Ablation - methods</topic><topic>Esophageal Fistula - diagnosis</topic><topic>Esophageal Fistula - epidemiology</topic><topic>Esophageal Fistula - etiology</topic><topic>Esophageal lesion</topic><topic>Esophageal temperature monitoring</topic><topic>Esophagoscopy - methods</topic><topic>Esophagus - injuries</topic><topic>Female</topic><topic>Germany</topic><topic>Heart Atria - pathology</topic><topic>Heart Atria - surgery</topic><topic>Hot Temperature - adverse effects</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative - adverse effects</topic><topic>Monitoring, Intraoperative - methods</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention &amp; control</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Thermometry - adverse effects</topic><topic>Thermometry - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Müller, Patrick, MD</creatorcontrib><creatorcontrib>Dietrich, Johannes-Wolfgang, MD</creatorcontrib><creatorcontrib>Halbfass, Philipp, MD</creatorcontrib><creatorcontrib>Abouarab, Aly</creatorcontrib><creatorcontrib>Fochler, Franziska</creatorcontrib><creatorcontrib>Szöllösi, Atilla</creatorcontrib><creatorcontrib>Nentwich, Karin, MD</creatorcontrib><creatorcontrib>Roos, Markus, MD</creatorcontrib><creatorcontrib>Krug, Joachim, MD</creatorcontrib><creatorcontrib>Schade, Anja, MD</creatorcontrib><creatorcontrib>Mügge, Andreas, MD</creatorcontrib><creatorcontrib>Deneke, Thomas, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Müller, Patrick, MD</au><au>Dietrich, Johannes-Wolfgang, MD</au><au>Halbfass, Philipp, MD</au><au>Abouarab, Aly</au><au>Fochler, Franziska</au><au>Szöllösi, Atilla</au><au>Nentwich, Karin, MD</au><au>Roos, Markus, MD</au><au>Krug, Joachim, MD</au><au>Schade, Anja, MD</au><au>Mügge, Andreas, MD</au><au>Deneke, Thomas, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>12</volume><issue>7</issue><spage>1464</spage><epage>1469</epage><pages>1464-1469</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Background Endoscopically detected esophageal lesions (EDELs) have been identified in apparently asymptomatic patients after catheter ablation of atrial fibrillation (AF). The use of esophageal probes to monitor luminal esophageal temperature (LET) during catheter ablation to protect esophageal damage is currently controversial. Objective The purpose of this study was to investigate the impact of the use of esophageal temperature probes during AF catheter ablation on the incidence of EDELs. Methods Eighty consecutive patients (mean age 63.8 ± 11.36 years; 68.8% men) with symptomatic, drug-refractory paroxysmal (n = 52, 65%) or persistent AF who underwent left atrial radiofrequency catheter ablation were prospectively enrolled. Posterior wall ablation was power limited (≤25 W). In the first 40 patients, LET was monitored continuously (group A), whereas no esophageal temperature probe was used in group B (n = 40 patients). Assessment of EDEL was performed by endoscopy within 2 days after radiofrequency catheter ablation. Results Overall, 13 patients (16%) developed EDELs after AF ablation. The incidence of EDELs was significantly higher in group A than group B (30% vs 2.5%, P &lt; .01). Within group A, patients who developed EDEL had higher maximal LET during AF ablation than patients without EDEL (40.97 ± 0.92°C vs 40.14 ± 1.1°C, P = .02). Multivariable logistic regression analysis revealed the use of an esophageal temperature probe as the only independent predictor for the development of EDEL (odds ratio 16.7, P &lt; .01). Conclusion The use of esophageal temperature probes in the setting of AF catheter ablation per se appears to be a risk factor for the development of EDEL.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25847474</pmid><doi>10.1016/j.hrthm.2015.04.005</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-3590-5980</orcidid><orcidid>https://orcid.org/0000-0002-9876-5380</orcidid><orcidid>https://orcid.org/0000-0003-3846-7565</orcidid></addata></record>
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subjects Aged
Atrial fibrillation
Atrial Fibrillation - surgery
Atrioesophageal fistula
Body Mass Index
Cardiovascular
Catheter ablation
Catheter Ablation - adverse effects
Catheter Ablation - methods
Esophageal Fistula - diagnosis
Esophageal Fistula - epidemiology
Esophageal Fistula - etiology
Esophageal lesion
Esophageal temperature monitoring
Esophagoscopy - methods
Esophagus - injuries
Female
Germany
Heart Atria - pathology
Heart Atria - surgery
Hot Temperature - adverse effects
Humans
Incidence
Male
Middle Aged
Monitoring, Intraoperative - adverse effects
Monitoring, Intraoperative - methods
Postoperative Complications - diagnosis
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Postoperative Complications - prevention & control
Risk Assessment
Risk Factors
Thermometry - adverse effects
Thermometry - methods
title Higher incidence of esophageal lesions after ablation of atrial fibrillation related to the use of esophageal temperature probes
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