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The influence of cryoballoon manipulation on luminal esophageal temperature during ablation for atrial fibrillation
Author(s) -
Chen Hongwu,
Liu Qiang,
Shehata Michael,
Ma Wei,
Xu Jing,
Cao Jianing,
Cingolani Eugenio,
Ehdaie Ashkan,
Jiang Chenyang,
Chen Minglong,
Chugh Sumeet S.,
Wang Xunzhang
Publication year - 2019
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13767
Subject(s) - medicine , ablation , pulmonary vein , atrial fibrillation , radiofrequency ablation , balloon , nuclear medicine , cardiology
Abstract Background Esophageal injury is related to a reduction in luminal esophageal temperature (LET) in second‐generation cryoballoon (CB) ablation; however, methods to prevent these reductions in temperature have not been well characterized. Methods Esophageal temperature was continuously monitored using a LET probe in patients undergoing pulmonary vein (PV) isolation using the second‐generation CB. A rotational maneuver of the CB was performed if the initial ablation resulted in a decrease of more than 4℃ in LET. The refrigerant injector near the distal CB pole was used as a fluoroscopic marker to measure the nearest distance between the CB and the LET probe. Results A total of 52 consecutive patients were enrolled in this study. The rotation was applied in 19 patients and 20 PVs (seven left superior pulmonary veins [LSPVs], seven left inferior PVs [LIPVs], and six right inferior PVs [RIPVs]) with a reduction in LET of more than 4℃ during freezing. The nadir temperature of CB applications was similar before and after CB rotation in all PVs. There was significant difference in the minimum LET before and after rotation during freezing in LSPVs (28.4 ± 3.7 vs 32.4 ± 2.3℃, P = .02), LIPVs (28.4 ± 1.4 vs 32.6 ± 2.7, P = .01) and RIPVs (26.1 ± 4.3 vs 34.0 ± 1.3℃, P = .002). The differences in mean balloon to LET distance were measured for all veins before and after rotation; LSPV (right anterior oblique [RAO], 11.0 ± 1.7 vs 13.8 ± 4.5 mm, P = .05); LIPV (RAO, 10.7 ± 4.3 vs 14.6 ± 6.1 mm, P = .03); RIPV (LAO, 11.8 ± 5.5 vs 14.2 ± 5.7 mm, P = .01). Conclusions CB rotational maneuvers during ablation can prevent significant reduction in LET and may prevent esophageal injury during the procedure.