Benefit to Decrease Esophageal Damage using an Ablation Catheter with Increased Irrigation Channels for Pulmonary Vein Isolation

Introduction An ablation catheter has been developed with six additional irrigation channels at the proximal end of the ablating electrode. We investigated the potential improvement of esophageal damage when the number of irrigation channels of the ablation catheter was increased during pulmonary vein isolation (PVI). Methods This study included a total of 296 consecutive patients with atrial fibrillation. One hundred forty-eight patients were randomly assigned to receive PVI using an ablation catheter with six distal irrigation channels (6C) and 148 patients to receive PVI using an ablation catheter with 12 distal irrigation channels (12C). The luminal esophageal temperature (LET) was monitored in all patients. Results A total of 639 radiofrequency energy applications (in 225 out of 296 patients) reached the cut-off temperature. The time for the LET to reach the cut-off temperature was shorter for the 6C than the 12C group, and the 6C group had a higher T max of the LET than the 12C group. Some patients experienced a transient drop in the LET (TDLET) just before the delivery of the energy. The site that caused a TDLET before the energy delivery always reached the cut-off temperature. TDLET was more frequent in the 6C group than in the 12C group. Conclusions The LET only showed a small difference between the 6C and 12C groups. In contrast, there may be a lower risk of esophageal injury with the 6C than the 12C if we use TDLET.