Impact of esophageal temperature monitoring guided atrial fibrillation ablation on preventing asymptomatic excessive transmural injury

Kunihiko Kiuchi, MD, FHRS; Katsunori Okajima, MD; Akira Shimane, MD; Gaku Kanda, MD; Kiminobu Yokoi, MD; Jin Teranishi, MD; Kousuke Aoki, MD; Misato Chimura, MD; Takayoshi Toba, MD; Shogo Oishi, MD; Takahiro Sawada, MD; Yasue Tsukishiro, MD; Tetsuari Onishi, MD; Seiichi Kobayashi, MD; Yasuyo Taniguchi, MD; Shinichiro Yamada, MD; Yoshinori Yasaka, MD; Hiroya Kawai, MD; Akihiro Yoshida, MD; Koji Fukuzawa, MD; Mitsuaki Itoh, MD; Kimitake Imamura, MD; Ryudo Fujiwara, MD; Atsushi Suzuki, MD; Tomoyuki Nakanishi, MD; Soichiro Yamashita, MD; Ken-ichi Hirata, MD; Hiroshi Tada, MD, FHRS; Hiro Yamasaki, MD; Yoshihisa Naruse, MD; Miyako Igarashi, MD; Kazutaka Aonuma, MD

doi:10.1016/j.joa.2015.07.003

Journal of Arrhythmia (Feb 2016)

Impact of esophageal temperature monitoring guided atrial fibrillation ablation on preventing asymptomatic excessive transmural injury

Kunihiko Kiuchi, MD, FHRS,
Katsunori Okajima, MD,
Akira Shimane, MD,
Gaku Kanda, MD,
Kiminobu Yokoi, MD,
Jin Teranishi, MD,
Kousuke Aoki, MD,
Misato Chimura, MD,
Takayoshi Toba, MD,
Shogo Oishi, MD,
Takahiro Sawada, MD,
Yasue Tsukishiro, MD,
Tetsuari Onishi, MD,
Seiichi Kobayashi, MD,
Yasuyo Taniguchi, MD,
Shinichiro Yamada, MD,
Yoshinori Yasaka, MD,
Hiroya Kawai, MD,
Akihiro Yoshida, MD,
Koji Fukuzawa, MD,
Mitsuaki Itoh, MD,
Kimitake Imamura, MD,
Ryudo Fujiwara, MD,
Atsushi Suzuki, MD,
Tomoyuki Nakanishi, MD,
Soichiro Yamashita, MD,
Ken-ichi Hirata, MD,
Hiroshi Tada, MD, FHRS,
Hiro Yamasaki, MD,
Yoshihisa Naruse, MD,
Miyako Igarashi, MD,
Kazutaka Aonuma, MD

Affiliations

Kunihiko Kiuchi, MD, FHRS: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Katsunori Okajima, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Akira Shimane, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Gaku Kanda, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Kiminobu Yokoi, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Jin Teranishi, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Kousuke Aoki, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Misato Chimura, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Takayoshi Toba, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Shogo Oishi, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Takahiro Sawada, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Yasue Tsukishiro, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Tetsuari Onishi, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Seiichi Kobayashi, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Yasuyo Taniguchi, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Shinichiro Yamada, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Yoshinori Yasaka, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Hiroya Kawai, MD: Department of Cardiology, Himeji Cardiovascular Center, Saishyo Kou 520, Himeji, Hyogo, Japan
Akihiro Yoshida, MD: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan
Koji Fukuzawa, MD: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan
Mitsuaki Itoh, MD: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan
Kimitake Imamura, MD: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan
Ryudo Fujiwara, MD: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan
Atsushi Suzuki, MD: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan
Tomoyuki Nakanishi, MD: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan
Soichiro Yamashita, MD: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan
Ken-ichi Hirata, MD: Division of Cardiovascular Medicine, Kobe University School of Medicine, Saishyo Kou 520, Himeji, Hyogo, Japan
Hiroshi Tada, MD, FHRS: Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Saishyo Kou 520, Himeji, Hyogo, Japan
Hiro Yamasaki, MD: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Saishyo Kou 520, Himeji, Hyogo, Japan
Yoshihisa Naruse, MD: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Saishyo Kou 520, Himeji, Hyogo, Japan
Miyako Igarashi, MD: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Saishyo Kou 520, Himeji, Hyogo, Japan
Kazutaka Aonuma, MD: Cardiovascular Division, Institute of Clinical Medicine, University of Tsukuba, Saishyo Kou 520, Himeji, Hyogo, Japan

DOI: https://doi.org/10.1016/j.joa.2015.07.003
Journal volume & issue: Vol. 32, no. 1
pp. 36 – 41

Abstract

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Background: Even with the use of a reduced energy setting (20–25 W), excessive transmural injury (ETI) following catheter ablation of atrial fibrillation (AF) is reported to develop in 10% of patients. However, the incidence of ETI depends on the pulmonary vein isolation (PVI) method and its esophageal temperature monitor setting. Data comparing the incidence of ETI following AF ablation with and without esophageal temperature monitoring (ETM) are still lacking. Methods: This study was comprised of 160 patients with AF (54% paroxysmal, mean: 24.0±2.9 kg/m2). Eighty patients underwent ablation accompanied by ETM. The primary endpoint was defined as the occurrence of ETI assessed by endoscopy within 5 d after the AF ablation. The secondary endpoint was defined as AF recurrence after a single procedure. If the esophageal temperature probe registered >39 °C, the radiofrequency (RF) application was stopped immediately. RF applications could be performed in a point-by-point manner for a maximum of 20 s and 20 W. ETI was defined as any injury that resulted from AF ablation, including esophageal injury or periesophageal nerve injury (peri-ENI). Results: The incidence of esophageal injury was significantly lower in patients whose AF ablation included ETM compared with patients without ETM (0 [0%] vs. 6 [7.5%], p=0.028), but not the incidence of peri-ENI (2 [2.5%] vs. 3 [3.8%], p=1.0). AF recurrence 12 months after the procedure was similar between the groups (20 [25%] in the ETM group vs. 19 [24%] in the non-ETM group, p=1.00). Conclusions: Catheter ablation using ETM may reduce the incidence of esophageal injury without increasing the incidence of AF recurrence but not the incidence of peri-ENI.

Published in Journal of Arrhythmia

ISSN: 1880-4276 (Print); 1883-2148 (Online)
Publisher: Wiley
Country of publisher: Australia
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://onlinelibrary.wiley.com/journal/18832148

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