Gastric hypomotility after second-generation cryoballoon ablation—Unrecognized silent nerve injury after cryoballoon ablation


      Few data are available on gastric hypomotility (GH) after cryoballoon pulmonary vein isolation. Also, the use of esophageal temperature monitoring for the prevention of endoscopically detected esophageal lesions (EDELs) is not well established.


      The purpose of this study was to investigate GH and the impact of an esophageal probe on EDELs during second-generation cryoballoon ablation.


      One hundred four patients with paroxysmal atrial fibrillation undergoing second-generation cryoballoon ablation under conscious sedation followed by esophagogastroscopy were prospectively included. Temperature probes were used in the first 40 (38.5%) patients, but not in the latter 64 (61.5%). Pulmonary vein isolation was performed with one 28-mm balloon using single 3-minute freeze techniques.


      Clinical and procedural characteristics were similar between the groups. Esophagogastroscopy 1.4 ± 0.5 days postablation demonstrated GH and EDELs in 18 (17.3%) and 9 (8.7%) patients. The incidence of GH was similar (7 of 40 vs 11 of 64; P = .967) between the groups, while that of EDELs was significantly higher in the former than in the latter group (8 of 40 vs 1 of 64; P < .0001). In multivariate analyses, the esophagus-right inferior pulmonary vein ostium distance (hazard ratio 0.870; 95% confidence interval 0.798–0.948; P = .002) was the sole predictor of GH, and the optimal cutoff for the prediction was 18.2 mm (sensitivity 88.1%; specificity 77.8%). The use of esophageal probes was the sole predictor of EDELs (hazard ratio 15.750; 95% confidence interval 1.887–131.471; P = .011). All collateral damage was asymptomatic and healed on repeat esophagogastroscopy at a mean of 2 ± 1 months postprocedure.


      Second-generation cryoballoon ablation is associated with an increased incidence of silent periesophageal nerve injury even using short freeze times, and anatomical information aids identifying high-risk populations. The use of esophageal probes increases the risk of EDELs.


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      Linked Article

      • To the Editor— Esophageal thermal probes and esophageal lesions during cryoablation
        Heart RhythmVol. 14Issue 10
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          May esophageal thermal probes (ETPs) produce esophageal thermal lesions (ETLs)? This question surfaced in the literature years ago, so far confined to radiofrequency ablation procedures. The article by Miyazaki et al1 is now exporting the subject to the framework of cryoablation. Its aim was to investigate the incidence of gastric hypomotility, but as a side result, the authors found that the occurrence of ETLs was higher in patients who had luminal esophageal temperature (LET) monitoring: 8 in the 40 monitored patients and only 1 in the 64 nonmonitored ones.
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