Abstract 1020 Impact of single vs. multi-sensor esophageal temperature probe for cryoballoon pulmonary vein isolation

Background: Thermal esophageal injury is a rare but severe complication following cryoballoon (CB) based pulmonary vein isolation. Continuous esophageal temperature monitoring is recommended to increase procedural safety during CB-PVI.

Objective: Comparison of accuracy and safety of an esophageal temperature probe (ETP) with a single thermocouple at its tip, which is part of a novel CB system, with a multi-sensor ETP with twelve thermocouples.

Methods: 20 consecutive patients (median age 74 years) with symptomatic AF, who underwent PVI with the novel CB system between June and November 2021 were enrolled in our single center study. In six patients, additional left atrial appendage (LAA) isolation was performed. All CB procedures were performed using continuous esophagus temperature monitoring with a multi-sensor ETP, as well as with a single-sensor ETP. The single ETP had to be adjusted during the CB-PVI using fluoroscopy.

Results: The single-sensor ETM probe of the novel CB system showed significantly higher esophagus temperatures in comparison to the multi-sensor ETM probe: 33.63.9 °C vs. 29.68.3° (p<0.01, mean valuestandard deviation (SD)). During simultaneous temperature monitoring, the maximum temperature difference between the single and multiple sensor ETM probe was of 24.2 °C (36.0 °C vs. 11.8 °C) during isolation of the LIPV.The greatest temperature differences were observed during isolation of the left pulmonary veins: left inferior PV (LIPV) at 7.29.6°C (p<0.01); left superior PV (LSPV) at 6.17.8°C (p<0.01); in comparison to the right pulmonary veins: right inferior PV (RIPV) at 2.56.8°C (p>0.05) and the right superior PV (RSPV) at -0.14.1°C (p>0.05). Temperature measurements during LAA isolation (n=6) did not differ (-0.40.3 °C).

In one patient, an esophagus ulceration of 2 cm diameter was observed at day 3 post ablation. In this case, esophageal temperature was 16°C (multiple ETM probe and 36°C single ETM probe).

Conclusions: A multi-sensor esophageal temperature probe seems to be more accurate in assessing esophageal temperature drops during CB-PVI compared to a new single-sensor probe. Therefore, we do not recommend the use of single ETM probes.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Impact of single vs. multi-sensor esophageal temperature probe for cryoballoon pulmonary vein isolation
H. L. Phan¹, C.-H. Heeger¹, A. Keelani¹, B. Kirstein¹, M. Feher¹, A. Traub¹, S. Hatahet¹, C. Eitel¹, J. Vogler¹, K.-H. Kuck², R. R. Tilz¹
¹Med. Klinik II / Kardiologie, Elektrophysiologie, Universitätsklinikum Schleswig-Holstein, Lübeck; ²Kardiologie, LANS Cardio Hamburg, Hamburg;
Background: Thermal esophageal injury is a rare but severe complication following cryoballoon (CB) based pulmonary vein isolation. Continuous esophageal temperature monitoring is recommended to increase procedural safety during CB-PVI. Objective: Comparison of accuracy and safety of an esophageal temperature probe (ETP) with a single thermocouple at its tip, which is part of a novel CB system, with a multi-sensor ETP with twelve thermocouples. Methods: 20 consecutive patients (median age 74 years) with symptomatic AF, who underwent PVI with the novel CB system between June and November 2021 were enrolled in our single center study. In six patients, additional left atrial appendage (LAA) isolation was performed. All CB procedures were performed using continuous esophagus temperature monitoring with a multi-sensor ETP, as well as with a single-sensor ETP. The single ETP had to be adjusted during the CB-PVI using fluoroscopy. Results: The single-sensor ETM probe of the novel CB system showed significantly higher esophagus temperatures in comparison to the multi-sensor ETM probe: 33.63.9 °C vs. 29.68.3° (p<0.01, mean valuestandard deviation (SD)). During simultaneous temperature monitoring, the maximum temperature difference between the single and multiple sensor ETM probe was of 24.2 °C (36.0 °C vs. 11.8 °C) during isolation of the LIPV.The greatest temperature differences were observed during isolation of the left pulmonary veins: left inferior PV (LIPV) at 7.29.6°C (p<0.01); left superior PV (LSPV) at 6.17.8°C (p<0.01); in comparison to the right pulmonary veins: right inferior PV (RIPV) at 2.56.8°C (p>0.05) and the right superior PV (RSPV) at -0.14.1°C (p>0.05). Temperature measurements during LAA isolation (n=6) did not differ (-0.40.3 °C). In one patient, an esophagus ulceration of 2 cm diameter was observed at day 3 post ablation. In this case, esophageal temperature was 16°C (multiple ETM probe and 36°C single ETM probe). Conclusions: A multi-sensor esophageal temperature probe seems to be more accurate in assessing esophageal temperature drops during CB-PVI compared to a new single-sensor probe. Therefore, we do not recommend the use of single ETM probes.
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