Keywords: Atrial fibrillation, Pulsed field ablation, Pulmonary vein isolation, Catheter ablation
Background:
Esophageal injury remains a major concern during atrial fibrillation (AF) ablation. Pulsed field ablation (PFA) has demonstrated a favorable safety profile, yet data on intraluminal esophageal temperature changes during focal PFA applications remain limited. We evaluated esophageal temperature dynamics during AF ablation using a novel dual-energy contact force-sensing catheter.
Methods:
Consecutive patients undergoing AF ablation with continuous intraluminal esophageal temperature monitoring were prospectively analyzed. Pulmonary vein isolation was performed using radiofrequency (RF) energy at the anterior pulmonary vein aspects and PFA at the posterior aspects. Posterior wall ablation was performed exclusively using PFA. Maximum esophageal temperature (TESO), maximum temperature increase (ΔTESO), and location-specific temperature changes were assessed.
Results:
Twelve patients underwent continuous esophageal temperature monitoring. Maximum observed TESO was 39.9°C and maximum observed ΔTESO was 3.6°C. Temperature increases ≥1°C occurred in 8/12 patients (66.7%), whereas ΔTESO ≥2°C was observed in only one patient (8.3%). No patient reached an esophageal temperature ≥40°C.
Mean ΔTESO was 0.4 ± 0.4°C at the right pulmonary veins, 1.0 ± 0.7°C at the left pulmonary veins, and 2.6 ± 1.5°C during posterior wall ablation. Corresponding maximum TESO values were 36.3 ± 0.6°C, 36.9 ± 0.8°C, and 38.8 ± 1.5°C, respectively. No esophageal complications were observed.
Conclusion:
In a dual-energy atrial fibrillation ablation workflow using posterior pulsed field ablation, posterior PFA was associated with only modest intraluminal esophageal temperature increases. No patient exceeded an esophageal temperature threshold of 40°C, supporting the favorable acute esophageal safety profile of focal PFA at the posterior left atrial wall.
