Abstract
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 language | English |
|---|---|
| Journal | Journal of Cardiovascular Electrophysiology |
| Volume | 35 |
| Issue number | 1 |
| Pages (from-to) | 78-85 |
| Number of pages | 8 |
| ISSN | 1045-3873 |
| DOIs | |
| Publication status | Published - 01.2024 |
Funding
B. K. received travel and congress sponsoring from EHRA, DGK and Pfizer related to this work and speaker honoraria from Biotronik, Impulse Dynamics, C.T.I. GmbH and Doctrina Med outside the submitted work.romwork. rom Biotronik, Abbott, Impulse Dynamics, Pfizer and speaker honoraria from Biotronik, Impulse Dynamics, C.T.I. GmbH and Doctrina Med outside the submitted work. C. H. H. received travel grants and research grants from Boston Scientific, Liftech, Biosense Webster and Cardiofocus and speaker honoraria from Boston Scientific, Biosense Webster, Cardiofocus and C.T.I. GmbH and Doctrina Med. outside the submitted work. R. R. T. is a consultant for Boston Scientific, Biotronik and Biosense Webster and received speaker honoraria from Biosense Webster, Medtronic, Boston Scientific and Abbot Medical. KHK reports grants and personal fees from Abbott Vascular, Medtronic, Biosense Webster outside the submitted work. H. L. P. received travel grants from Cardiofocus and C.T.I. outside the submitted work. Other authors: No disclosures. Disclosures:
Research Areas and Centers
- Centers: Cardiological Center Luebeck (UHZL)
DFG Research Classification Scheme
- 2.22-12 Cardiology, Angiology
