Esophageal deviation using the transesophageal echocardiography probe during atrial fibrillation radiofrequency ablation: a prospective observational study.

BACKGROUND: Esophageal injury is a recognized complication of atrial fibrillation (AF) radiofrequency ablation, during pulmonary vein isolation (PVI) or posterior wall ablation. Mechanical esophageal deviation has emerged as a promising preventive strategy, however, commercially available deviation tools are not accessible outside the United States. We evaluated the feasibility and effectiveness of using the transesophageal echocardiography (TEE) probe-readily available in many electrophysiology labs-for esophageal deviation during AF ablation.

METHODS: In this prospective observational study, patients undergoing PVI ± additional atrial ablation for AF were treated using esophageal deviation (Dev-Group) or using standard care (Std-Group) depending on the operating electrophysiologist. In the Dev-Group, esophageal position was identified using barium ingestion, and the TEE probe was manipulated to achieve maximal displacement away from posterior pulmonary vein (PV) ostia. Deviation of esophageal trailing edge >10 mm from PV was defined as successful. Esophageal temperature was monitored in both groups using a multi-sensor probe.

RESULTS: Sixty patients (30 per group; 60 PV pairs each) were included. In the Dev-Group, 78% (47/60) of PV pairs achieved >10 mm esophageal separation vs. 30% (18/60) at baseline (p < 0.001); PV-esophagus overlap dropped from 52% (31/60) at baseline to 2% (1/60) after deviation (p < 0.001). Temperature rises >38 °C were observed during 2 radiofrequency applications in the Dev-Group versus 75 in the Std-Group (p < 0.001). No esophageal injuries were reported.

CONCLUSION: TEE probe-guided esophageal deviation appears as a practical and effective technique for reducing esophageal proximity and thermal exposure during AF ablation, offering a valuable safety enhancement where dedicated tools are unavailable.