Esophageal temperature change and esophageal thermal lesions after pulmonary vein isolation using the novel endoscopic ablation system

Background Pulmonary vein isolation (PVI) is an established treatment option for paroxysmal atrial fibrillation. Recently, a novel endoscopic ablation system (EAS) was introduced. The incidence and severity of ablation-induced esophageal thermal lesions (ETLs) are unknown. Objective The purpose of this study was to investigate the incidence and severity of ablation-induced ETLs. Methods This prospective analysis compared two groups: group A underwent EAS-based PVI, and group B received PVI using radio frequency current (RFC). If esophageal temperature measured via an endoluminal temperature probe exceeded 38.5°C, energy application was stopped immediately. Endoscopy was performed 2 days postablation. Results Forty patients (20 female, mean age 56 ± 10 years) were treated with the EAS system (group A). In 20 patients (seven female, mean age 63 ± 9 years) RFC-based PVI was performed (group B). Esophageal endoscopy was performed 2.1 ± 0.8 (group A) and 2.8 ± 1.2 days postablation (group B), respectively. In 7/40 patients (18%) in group A, thermal lesions (four thermal ulcerations, three minimal thermal lesions) were detected. In group B, 3/20 patients (15%) displayed thermal lesions (three minimal thermal lesions). All thermal lesions resolved upon repeat endoscopy performed 8 ± 6 (group A) and 5 ± 1 days (group B) after initial endoscopy. Conclusion In the EAS group, ETLs were found in 18% of patients, as compared with in 15% in the RFC group. In patients with ETLs, ulcerations were found in 57% in the EAS group, as compared with 0% in the RFC group. This may indicate that the quality of thermal lesions is more severe in the EAS group. Further investigation is required.