BACKGROUND
Cryoballoon ablation is effective for the treatment of atrial fibrillation. As every interventional approach, this procedure is associated with risks of different complications. One of them is esophageal lesion caused by critical low temperature inside the esophagus. This event can result a fatal outcome. We offer a new method for prevention of esophageal lesions that lies in a special breathing pattern. In some cases, this approach makes it possible to prevent temperature decrease up to critical values inside the esophagus.
OBJECTIVE
To evaluate the safety and efficacy of a new method of active temperature control inside the esophagus during cryoballoon ablation for atrial fibrillation.
MATERIAL AND METHODS
A pilot prospective study included 70 patients with atrial fibrillation scheduled for cryoballoon ablation. In all cases, we measured temperature inside the esophagus using multi-sensor catheters. We used a special breathing maneuver for 17 times in 14 patients because of critical temperature drop during the procedure.
RESULTS
All patients were discharged with sinus rhythm and confirmed isolation of pulmonary vein orifices. We could achieve planned duration of cryoablation in 11 out of 17 cases using breathing maneuver. In other cases, cryoablation was interrupted because of temperature drop up to 20 °C inside the esophagus. Six patients underwent esophagoscopy the next day, and erosion de novo was found in 2 cases. Esophageal temperature monitoring during cryoablation becomes more actual, that can be associated with accumulation of experience, analysis of complications and significant number of reports devoted to this issue. It is necessary to find safe and effective decisions for prevention of esophageal lesions. The above-mentioned special breathing pattern allows you to safely reduce the risk of esophageal lesion and, in some cases, not sacrifice the duration of cryotherapy. Repeatability and safety distinguish our method from esophageal displacement devices.
CONCLUSION
A new breathing maneuver during cryoablation for atrial fibrillation seems to be safe and effective. This method may be reproducible because specific surgical skill is not necessary for this technique. In some cases, this measure may be determinative to achieve pulmonary vein isolation as a strong predictor of effective management of atrial fibrillation.
