Impact of pulsed field ablation on intraluminal esophageal temperature

Bettina Kirstein*, Christian H. Heeger, Julia Vogler, Charlotte Eitel, Marcel Feher, Huong Lan Phan, Ilias Mushfiq, Anna Traub, Sascha Hatahet, Omar Samara, Behnam Subin, Karl Heinz Kuck, Roland R. Tilz

*Corresponding author for this work
1 Citation (Scopus)


Introduction: Atrio-esophageal fistula after esophageal thermal injury (ETI) is one of the most devastating complications of available energy sources for atrial fibrillation (AF) ablation. Pulsed field ablation (PFA) uses electroporation as a new energy source for catheter ablation with promising periprocedural safety advantages over existing methods due to its unique myocardial tissue sensitivity. In preclinical animal studies, a dose-dependent esophageal temperature rise has been reported. In the TESO-PFA registry intraluminal esophageal temperature (TESO) changes in a clinical setting are evaluated. Methods: Consecutive symptomatic AF patients (62 years, 67% male, 61% paroxysmal AF, CHA2DS2Vasc Score 2) underwent first-time PFA and were prospectively enrolled into our registry. Eight pulse trains (2 kV/2.5 s, bipolar, biphasic, x4 basket/flower configuration each) were delivered to each pulmonary vein (PV). Two extra pulse trains per PV in flower configuration were added for wide antral circumferential ablation. Continuous intraluminal esophageal temperature (TESO) was monitored with a 12-pole temperature probe. Results: Median TESO change was statistically significant and increased by 0.8 ± 0.6°C, p <.001. A TESO increase ≥ 1°C was observed in 10/43 (23%) patients. The highest TESO measured was 40.3°C. The largest TESO difference (∆TESO) was 3.7°C. All patients remained asymptomatic considering possible ETI. No atrio-esophageal fistula was reported on follow-up. Conclusion: A small but significant intraluminal esophageal temperature rise can be observed in most patients during PFA. TESO rise over 40°C is rare. The clinical implications of the observed findings need to be further evaluated.

Original languageEnglish
JournalJournal of Cardiovascular Electrophysiology
Issue number1
Pages (from-to)78-85
Number of pages8
Publication statusPublished - 01.2024

Research Areas and Centers

  • Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

  • 205-12 Cardiology, Angiology

Cite this