Objectives: Additional Cryoballon (CB) left atrial roof line has shown to be beneficial in arrhythmia freedom outcome in persistent atrial fibrillation (PERS-AF). However, in up to 18% of patients with CB-PVI esophageal lesions (EL) can be detected by endoscopy. Therefore additional CB ablation beyond PVI, such as roof ablation, rises concerns of possible increased incidence of EL. 

Methods: 100 consecutive Patients were enrolled in this prospective observational study. Group A (n=50 with PAF) received CB PVI only, Group B (n=50 with PERS-AF) were treated with an additional CB roof line. All procedures were performed under analgosedation (with piritramid and diazepam) without the use of an esophageal temperature probe (ETP). Endoscopic examination was performed in all patients 24 hours after the ablation treatment. EL were classified into the known stages I to IIIb (Kansas City Classification).

Results: Mean minimum temperatures at PVI did not differ between the two groups (A/B -50C°, respectively). Roofline was performed applying on average 4 (median 3-6) freezes with temperature of -40°C (-33 to -46°C). Esophageal injuries were detected in 1 % of all patients (n=1 in Group A – stage IIa).

Conclusion: CB-PVI with additional roof line in PERS-AF is not associated with increased EL. Moreover, performing the procedure under analgosedation with piritramide and diazepam without the use of an ETP seems to reduce the rate of EL and possibly simplify the procedure.