Esophageal temperature monitoring during radiofrequency ablation of atrial fibrillation a meta-analysis

Ketan Koranne, Indranill Basu-Ray, Valay Parikh, Mark Pollet, Suwei Wang, Nilesh Mathuria, Dhanunjaya Lakkireddy, Jie Cheng

Research output: Contribution to journalArticle

14 Scopus citations

Abstract

Atrio-esophageal fistula is an infrequent but devastating complication of catheter-based ablation of atrial fibrillation (AF). Thermal esophageal injury may be the precursor of atrio-esophageal fistula. Here, we evaluated the role of esophageal temperature monitoring in preventing thermal esophageal injury during pulmonary vein isolation for AF with radiofrequency energy. In this meta-analysis, we searched the Pub Med, Cochrane, Scopus, Embase, and Refworks databases for all published studies from January 2004 to June 2016 to evaluate the role of esophageal temperature monitoring. We searched for terms esophageal temperature monitoring, AF, radiofrequency ablation, atrio-esophageal fistula, and thermal esophageal injury. We included studies comparing luminal esophageal temperature (LET) monitoring with no LET monitoring during radiofrequency ablation of AF. We excluded studies in which post-ablation esophagogastroduodenoscopy (EGD) was not performed to identify esophageal thermal injuries. To perform the meta-analysis, we used Review Manager statistical software and a fixed-effects modeling to derive the outcomes. Given significant heterogeneity between the studies, we used meta-regression analysis to adjust for age and sex. We identified 4 non-randomized controlled trials that met our search criteria and included a total of 411 patients (n=235 in the LET monitoring group; n=176 in the no LET monitoring group) in the analysis. There were 21 (8.9%) patients with thermal esophageal injury in the LET monitoring group and 12 (6.8%) in the no LET monitoring group. The pooled odds ratio was 0.66 (0.23-1.89), indicating no statistically significant differences between the 2 groups with regard to esophageal injury. Because of the small sample size and the non-randomized nature of the trials, we observed significant heterogeneity in outcomes among the trials. The role of esophageal temperature monitoring in reducing the risk of esophageal thermal lesions during pulmonary vein isolation for AF has not been established, and more studies including randomized controlled trials are needed to assess its true impact.

Original languageEnglish (US)
JournalJournal of Atrial Fibrillation
Volume9
Issue number4
StatePublished - Dec 1 2016

Keywords

  • Atrial fibrillation
  • Atrial fibrillation ablation
  • Atrio-esophageal fistula
  • Esophageal temperature monitoring

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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