Comparison between single- and multi-sensor oesophageal temperature probes during atrial fibrillation ablation: thermodynamic characteristics

• Published in: Europace (London, England) Vol. 17; no. 6; pp. 891 - 897
• Main Authors: Tschabrunn, Cory M, Silverstein, Joshua, Berzin, Tyler, Ellis, Ethan, Buxton, Alfred E, Josephson, Mark E, Anter, Elad
• Format: Journal Article
• Language: English
• Published: England 01-06-2015
• Subjects: Aged; Animals; Atrial Fibrillation - surgery; Catheter Ablation - adverse effects; Catheter Ablation - methods; Endoscopy, Digestive System; Esophagus - diagnostic imaging; Esophagus - injuries; Female; Heart Atria - diagnostic imaging; Humans; Male; Middle Aged; Monitoring, Intraoperative - instrumentation; Pulmonary Veins - surgery; Radiography; Sus scrofa; Swine; Thermometers; Oesophageal temperature monitoring; Oesophageal injury; Single-sensor probe; Atrial fibrillation; Multi-sensor probe; Pulmonary vein isolation
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euu356

Oesophageal temperature monitoring with single-sensor probe (SSP) has a variable ability to predict oesophageal ulceration as a consequence of pulmonary vein isolation (PVI). Multi-sensor self-expandable probes (MSPs) may offer improved thermal monitoring. The objective of this study was to compare the thermodynamic characteristics of both probes during PVI.
This prospective study enrolled 20 patients undergoing index PVI. Ten patients (group A) underwent dual monitoring with SSP and MSP and 10 control patients (group B) were monitored with SSP alone. Time to initial rise (>0.2°C), time to 1.0°C rise, peak temperature, and decay were recorded with each posterior wall lesion (20 W, 198 applications). The operator was blinded to the MSP temperature data and ablation was only interrupted when SSP temperature increased by ≥2°C. All patients underwent endoscopy within 24 h. Initial temperature increase was detected earlier with MSP (13.4 ± 7.5 vs. 30.5 ± 15.4 s; P < 0.001); led to shorter time to 1.0°C rise (18.5 ± 10.1 vs. 32.1 ± 12.0 s; P < 0.001); and higher change in peak temperature (1.6 ± 2.0 vs. 0.60 ± 0.53°C; P < 0.001). Decay time was similar between the probes (146.1 ± 35.3 vs. 150.4 ± 48.4 s; P = 0.89). The incidence of oesophageal ulceration was similar between the Groups A and B (5 and 4, respectively). Multi-sensor self-expandable probe provided greater sensitivity (100 vs. 60%) and similar specificity (60%) for detection of oesophageal ulceration. Five swine underwent oesophageal mapping before and after MSP placement without alteration in size or position.
Multi-sensor probes provide a superior thermodynamic profile. Its clinical value in reducing oesophageal injury requires further evaluation.