Luminal esophageal temperature predicts esophageal lesions after second-generation cryoballoon pulmonary vein isolation

Heart Rhythm. 2013 Jun;10(6):789-93. doi: 10.1016/j.hrthm.2013.02.021. Epub 2013 Feb 19.


Background: The novel second-generation cryoballoon (CB) facilitates pulmonary vein isolation (PVI) by improved surface cooling. The impact of this redesign on collateral damage is unknown.

Objective: To investigate the incidence of esophageal lesions after PVI using the second-generation CB and the role of luminal esophageal temperature (LET) measurement as a predictor of lesion formation.

Methods: Thirty-two consecutive patients underwent PVI using the second-generation 28 mm CB. Target application time was 2 × 240 seconds. Ninety-two percent of the PVs were isolated after 1 cryoenergy application. Complete PVI was achieved in all patients. LET with 3 thermocouples was continuously measured during cryoenergy application. Freezing was interrupted only if weakening/loss of phrenic nerve function or low LET (<5 °C) was observed.

Results: The lowest measured LET was-12 °C (despite cryoapplication interruption). Postprocedural gastroesophagoscopy was performed after 1-3 days in all patients and showed lesions in 6 of 32 (19%) patients. A minimum LET of≤12 °C predicted esophageal lesions with 100% sensitivity and 92% specificity (area under the receiver-operator characteristic curve 0.97; 95% CI 0.93-1.02; P = .001). Persistent phrenic nerve palsy occurred in 2 (6%) patients during ablation at the right inferior pulmonary vein. Repeat gastroesophagoscopy confirmed healing of lesions after 16 ± 14 days.

Conclusions: Second-generation 28 mm CB PVI is associated with significant esophageal cooling, resulting in lesion formation in 19% of the patients. LET measurement accurately predicts lesion formation and may enhance the safety of the novel device.

MeSH terms

  • Aged
  • Atrial Fibrillation / surgery*
  • Body Temperature
  • Cryosurgery / adverse effects*
  • Cryosurgery / instrumentation
  • Cryosurgery / methods*
  • Electrophysiologic Techniques, Cardiac
  • Equipment Design
  • Esophageal Diseases / diagnosis
  • Esophageal Diseases / etiology*
  • Esophagoscopy
  • Female
  • Fluoroscopy
  • Gastroscopy
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Veins / surgery