{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:51:35Z","timestamp":1760244695130,"version":"build-2065373602"},"reference-count":12,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T00:00:00Z","timestamp":1669334400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Although epicardial bipolar radiofrequency ablation should diminish the risk of esophageal thermal injury in comparison to an endocardial ablation, cases of lethal atrio-esophageal fistula have been reported. To better understand this risk and to reduce the possibility of a thermal injury, we monitored the esophageal temperature with the Circa S-Cath\u2122 temperature probe during and immediately after the ablation while implementing three procedural safety measures. Twenty patients (15 males; 63 \u00b1 10 years) were prospectively enrolled (November 2019\u2013February 2021). All patients underwent an epicardial ablation procedure, including an antral left and right pulmonary vein isolation with bidirectional bipolar clamping, and a roof and inferior line using unidirectional bipolar radiofrequency. Three procedural preventive mitigations were implemented: (1) transesophageal echocardiographic visualization of the atrio-esophageal interface, with probe retraction before the energy delivery; (2) lifting the ablated tissue away from the esophagus during an energy application; and (3) a 30 s cool-off and irrigation period after the energy delivery. The esophageal temperature was recorded using an insulated multisensory intraluminal esophageal temperature probe (Circa S-Cath\u2122). Of the 20 patients enrolled, 7 patients had paroxysmal atrial fibrillation (AF), 8 persistent AF and 5 longstanding persistent AF. The average maximum luminal esophageal temperature observed was 36.2 \u00b1 0.7 \u00b0C (34.8\u201338.2 \u00b0C). In our clinical experience, no abrupt increase in the luminal esophageal temperature above the baseline was observed. Since no measurements exceeded the threshold of 39 \u00b0C, no prompt interruption of energy delivery was required. Intraluminal esophageal temperature monitoring is feasible and can be helpful in confirming correct catheter position and safe energy application in bipolar epicardial left atrial ablation. Intra-procedural preventive mitigations should be implemented to reduce the risk of esophageal temperature rises.<\/jats:p>","DOI":"10.3390\/jcm11236939","type":"journal-article","created":{"date-parts":[[2022,11,25]],"date-time":"2022-11-25T03:34:24Z","timestamp":1669347264000},"page":"6939","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Esophageal Protection and Temperature Monitoring Using the Circa S-Cath\u2122 Temperature Probe during Epicardial Radiofrequency Ablation of the Pulmonary Veins and Posterior Left Atrium"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9142-8608","authenticated-orcid":false,"given":"Rani","family":"Kronenberger","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5422-4187","authenticated-orcid":false,"given":"Orlando","family":"Parise","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ines","family":"Van Loo","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7746-989X","authenticated-orcid":false,"given":"Sandro","family":"Gelsomino","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Welch","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9351-0760","authenticated-orcid":false,"given":"Carlo","family":"De Asmundis","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"La Meir","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/europace\/eun001","article-title":"Incidence of oesophageal wall injury post-pulmonary vein antrum isolation for treatment of patients with atrial fibrillation","volume":"10","author":"Schmidt","year":"2008","journal-title":"Europace"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"8202","DOI":"10.1038\/s41598-020-65185-9","article-title":"Management of Atrio-esophageal Fistula Induced by Radiofrequency Catheter Ablation in Atrial Fibrillation Patients: A Case Series","volume":"10","author":"Kim","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.4022\/jafib.2386","article-title":"Intraluminal Esophageal Temperature Monitoring Using the Circa S-CathTM Temperature Probe to Guide Left Atrial Ablation in Patients with Atrial Fibrillation","volume":"13","author":"Bhuta","year":"2020","journal-title":"J. Atr. Fibrillation"},{"key":"ref_5","first-page":"891","article-title":"Comparison between single- and multi-sensor oesophageal temperature probes during atrial fibrillation ablation: Thermodynamic characteristics","volume":"17","author":"Tschabrunn","year":"2015","journal-title":"EP Eur."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1016\/j.athoracsur.2020.01.057","article-title":"Unilateral Left-sided Thoracoscopic Ablation of Atrial Fibrillation","volume":"110","author":"Maesen","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kronenberger, R., Van Loo, I., de Asmundis, C., Aerts, M., Gelsomino, S., Umbrain, V., Chierchia, G.-B., and La Meir, M. (2021). Esophageal Findings in the Setting of a Novel Preventive Strategy to Avoid Thermal Lesions during Hybrid Thoracoscopic Radiofrequency Ablation for Atrial Fibrillation. J. Clin. Med., 10.","DOI":"10.3390\/jcm10214981"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1161\/CIRCULATIONAHA.105.551291","article-title":"Anatomic Relations Between the Esophagus and Left Atrium and Relevance for Ablation of Atrial Fibrillation","volume":"112","author":"Cabrera","year":"2005","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1093\/europace\/euaa276","article-title":"Randomized comparison of oesophageal protection with a temperature control device: Results of the IMPACT study","volume":"23","author":"Leung","year":"2021","journal-title":"Europace"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1111\/jce.14193","article-title":"Incidence of acute thermal esophageal injury after atrial fibrillation ablation guided by prespecified ablation index","volume":"30","author":"Halbfass","year":"2019","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1161\/CIRCEP.108.789552","article-title":"Esophageal injury and temperature monitoring during atrial fibrillation ablation","volume":"1","author":"Singh","year":"2008","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.jtcvs.2017.02.027","article-title":"Expert consensus guidelines: Examining surgical ablation for atrial fibrillation","volume":"153","author":"Ad","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/6939\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:26:21Z","timestamp":1760145981000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/6939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,25]]},"references-count":12,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11236939"],"URL":"https:\/\/doi.org\/10.3390\/jcm11236939","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,11,25]]}}}