Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-AB09 - Advances in Radiofrequency Ablation Lesion Science: Optimizing Settings and Outcomes (ID 46) Abstract

D-AB09-05 - The Contact Force Over The Posterior Wall Best Correlates With Esophageal Temperature Elevations During Atrial Fibrillation Ablation (ID 756)


Background: Atrioesophageal fistula is a rare and serious complication of atrial fibrillation (AF) ablation. Esophageal temperature has been used as a surrogate for esophageal heating and potential damage.
Objective: To determine ablation parameters and clinical predictors of esophageal temperature elevation (ETE) during AF ablation.
Methods: The esophageal temperature was systematically recorded on every ablation that was close to the esophagus, after this structure was visualized on the Mapping system (Carto 3) using the ESOPHASTAR. A point by point PVI (paroxysmal AF) and PVI + Posterior wall Isolation (Persistent AF) ablation was done in 18 consecutive patients. We defined an elevation of temperature as a delta of 0.5 Celsius above the starting baseline. Baseline demographics and ablation parameters of the two groups were compared. Multivariate regression was used to identify the significant contributors to ETE. And a Linear regression was used to analyze the correlation between force and temperature.
Results: A total of 111 ablation lesions were analyzed. Of these, 68 were associated with a low temperature elevation (LTE) and 43 were associated with a high temperature elevation (HTE). Compared to LTE group, patients in HTE group were older (68 vs. 64 years old), and had significantly higher rate of coronary artery disease (26% vs. 9%). HTE group had a higher proportion of persistent AF than LTE group (50% vs. 28%). Among all the ablation parameters analyzed, average force was significantly higher in the HTE group (Fig 1).
Conclusion: Among several ablation parameters, the difference in contact force seems to better predict esophageal temperature rises during AF ablation.