Low Incidence of Esophageal Lesions After Pulmonary Vein Isolation Using Contact-Force Sensing Catheter Without Esophageal Temperature Probe

Christian Blockhaus; Patrick Müller; Stephan vom Dahl; Silke Leonhardt; Dieter Häussinger; Shqipe Gerguri; Lucas Clasen; Jan Schmidt; Muhammed Kurt; Christoph Brinkmeyer; Malte Kelm; Dong-In Shin; Hisaki Makimoto

doi:10.1536/ihj.16-382

Clinical Studies

Low Incidence of Esophageal Lesions After Pulmonary Vein Isolation Using Contact-Force Sensing Catheter Without Esophageal Temperature Probe

Christian Blockhaus, Patrick Müller, Stephan vom Dahl, Silke Leonhardt, Dieter Häussinger, Shqipe Gerguri, Lucas Clasen, Jan Schmidt, Muhammed Kurt, Christoph Brinkmeyer, Malte Kelm, Dong-In Shin, Hisaki Makimoto

Author information

Christian Blockhaus
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
Patrick Müller
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
Stephan vom Dahl
Division of Gastroenterology, Hepatology and Infectiology, Department of Medicine, University Hospital Düsseldorf
Silke Leonhardt
Division of Gastroenterology, Hepatology and Infectiology, Department of Medicine, University Hospital Düsseldorf
Dieter Häussinger
Division of Gastroenterology, Hepatology and Infectiology, Department of Medicine, University Hospital Düsseldorf
Shqipe Gerguri
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
Lucas Clasen
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
Jan Schmidt
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
Muhammed Kurt
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
Christoph Brinkmeyer
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
Malte Kelm
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
Dong-In Shin
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf
Hisaki Makimoto
Division of Cardiology, Pulmonary Diseases and Vascular Medicine, Department of Medicine, University Hospital Düsseldorf

Keywords: Atrial fibrillation, Atrio-esophageal fistula, Radiofrequency ablation, Complications

JOURNAL FREE ACCESS

2017 Volume 58 Issue 6 Pages 880-884

DOI https://doi.org/10.1536/ihj.16-382

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Abstract

Pulmonary vein isolation (PVI) is a cornerstone therapy for atrial fibrillation (AF). Although severe complications are rather rare, the development of an atrio-esophageal fistula (AEF) is a fatal complication with a very high mortality even after surgical treatment. The use of esophageal temperature probes (ETP) during PVI may protect the esophagus but it is still under debate since the ETP may also lead to esophageal lesions. The aim of this study was to evaluate the clinical safety of PVI using contact-force (CF) sensing catheter without esophageal temperature monitoring.

We investigated 70 consecutive patients who underwent point-by-point PVI without usage of ETP and who underwent esophago-gastro-duodenoscopy (EGD) with detailed evaluation of the esophagus after the index PVI procedure. The operator attempted to keep CF within the 10-40 g range. The incidences of esophageal lesions (EDEL) detected by endoscopy were then analyzed.

Two of 70 patients (2.9%) showed EDEL consisting of one longitudinal ulcer-like erythematous lesion with fibrin and a different one consisting of a round-shaped lesion surrounded by erythema and petechial hemorrhage. All EDEL healed within two weeks under high proton-pump inhibitor therapy without developing AEF as proven by a second EGD of the esophagus.

Point-by-point PVI without usage of ETP showed a low incidence of EDEL (2.9%); atrio-esophageal fistula was absent. Further studies on the necessity of ETP under CF control are necessary.

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