Esophagus‐Related Complications During Second‐Generation Cryoballoon Ablation—Insight from Simultaneous Esophageal Temperature Monitoring from 2 Esophageal Probes

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Abstract
Esophagus‐Related Complications After Cryoablation: Background: Monitoring luminal esophageal temperatures (LETs) helps predict esophageal thermal lesions (ETLs) after catheter ablation. This study aimed to evaluate esophagus‐related complications after second‐generation cryoballoon ablation under simultaneous LETs monitoring from 2 esophageal probes.Methods: Forty consecutive paroxysmal atrial fibrillation patients undergoing second‐generation cryoballoon ablation under conscious sedation followed by esophagogastroscopy were prospectively included. Two temperature probes inserted bi‐nasally (both non‐deflectable in 13, non‐deflectable and deflectable in 27 patients) were used for LET monitoring. Pulmonary vein isolation was performed with one 28‐mm balloon using single 3‐minute freeze techniques.Results: The lowest LETs significantly correlated between different probes; however, deflectable probe showed significantly lower nadir LETs than non‐deflectable probes (14.6 ± 9.2 vs. 20.0 ± 10.6 ℃, P<0.0001). Esophagogastroscopy post‐ablation demonstrated ETLs and gastroparesis in 8 (20%) and 7 (17.5%) patients (total 13 [32.5%]), respectively. The optimal cutoff for the lowest LET measured on any probe for predicting no ETLs was 12.8 ℃ (sensitivity 78.1%, specificity 100%). When using deflectable and non‐deflectable catheters, the optimal cutoff point for the lowest LET for predicting no ETLs was 11.4 ℃ (sensitivity 70.0%, specificity 100%) and 19.4 ℃ (sensitivity 63.6%, specificity 100%), respectively. No ETLs were detected in 12 (30%) patients with the esophagus located between the left atrium and spine. All esophagus‐related complications were asymptomatic and had healed on repeat esophagogastroscopy by a mean of 53 ± 25 days after the procedure.Conclusions: The lowest LET highly depended on the temperature probe location. However, if a different cutoff value was applied, LET monitoring, regardless of the probe type, and anatomical information might help predict ETLs during second‐generation cryoballoon ablation.

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