Calculated parameters of luminal esophageal temperatures predict esophageal injury following conventional and high‐power short‐duration radiofrequency pulmonary vein isolation

摘要

Abstract Background Luminal esophageal temperature (LET) monitoring is not associated with reduced esophageal injury following pulmonary vein isolation (PVI). Objective Detailed analysis of (the temporal and spatial gradients of) LET measurements may better predict the risk for esophageal injury. Methods Between January 2020 and December 2021, LET maxima, duration of LET rise above baseline, and area under the LET curve (AUC) were calculated offline and correlated with (endoscopy and endoscopic ultrasound detected) esophageal injury (i.e., mucosal esophageal lesions ELs, periesophageal edema, and gastric motility disorders) following PVI using moderate‐power moderate‐duration (MPMD 25–30 W/25–30s) and high‐power short‐duration (HPSD 50 W/13s) radiofrequency (RF) settings. Results 63 patients (69?±?9 years old, 32 male, 51 MPMD and 12 HPSD) were studied. The esophageal injury was frequent (40 in both groups), mucosal ELs were more common with MPMD, and edema was frequently observed following HPSD. RF‐duration, total RF‐energy at the left atrial (LA) posterior wall, and distance between LA and esophagus were not different between patients with/without esophageal injury. In contrast, to LET and LET duration above baseline, AUC was the best predictor and significantly increased in patients with esophageal injury (3422 vs. 2444 K.s). Conclusion For both ablation strategies, AUC of the LET curves best predicted esophageal injury. HPSD is associated with similar rates of esophageal injury when (mostly subclinical) periesophageal alterations (that are of unclear clinical relevance) are included. Whether integration of these calculated LET parameters is useful to prevent esophageal injury remains to be seen.