Intraoperative esophageal temperature monitoring during cryoballoon ablation in patients with atrial fibrillation

Aim. To study the frequency of a significant decrease in the esophageal temperature during the standard and “extended” cryoballoon ablation (CBA) procedure in patients with paroxysmal and persistent atrial fibrillation (AF).

Methods. The study included 160 patients (median age 66 [57;70] years, 90 [56.3%] male) with symptomatic paroxysmal and persistent AF. 139 (80.0%) patients with paroxysmal AF underwent pulmonary vein (PV) CBA, and 21 (20.0%) patients with persistent AF underwent “extended” PV CBA in combination with cryoablation of the left atrial posterior wall. At all stages of CBA exposure, esophageal temperature was assessed using the Astrocard Esosafety multichannel esophageal temperature monitoring system (MTP) (Astrocard, JSC Meditek). The criterion for stopping the CBA was considered to be a decrease in temperature below 20 °C.

Results. Electrical isolation of PV was achieved in all 160 patients with CBA. In the group of standard CBA PV (n=139), the temperature < 20 °C was observed significantly more often than in patients with a “central” esophagus (81% vs. 5.7%, p < 20 °C in MTP was determined in 22 (16%) patients, with an average value of 17.23±1.74 °C. In 13 of 22 (59%) patients the temperature < 20 °C in MTP was recorded with CBA of the left lower PV. In the group of “extended” CBA (n=21), the temperature < 20 °C in MTP was determined in 18 (86%) patients, with an average value of 17.1±0.6 °C. When evaluating the fluoroscopic options for the location of the MTP sensor in the esophagus relative to PV, the esophagus of “central localization” was determined in 105 (76%) patients, “left localization” in 21 (15%) patients, and “right localization” in 13 (9%) patients. In patients with a “left-sided” esophagus a decrease in temperature < 20 °C was observed significantly more often than in patients with a “central” esophagus (81% vs. 5.7%, p < 0.05 according to the Fisher exact test). No serious complications were observed during the follow-up period after CBA.

Conclusion. Temperature monitoring using the “Astrocard Esosafety” system allows us to assess the dynamics of temperature changes in the esophagus during standard and “extended” CBA of the LA, providing important information for selecting ablation strategies 

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