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Further mechanistic evidence against luminal esophageal temperature monitoring?
  • James Daniels,
  • Erik Kulstad
James Daniels
The University of Texas Southwestern Medical Center
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Erik Kulstad
The University of Texas Southwestern Medical Center
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Abstract

We congratulate Kar et al. on their elegant study evaluating ex-vivo temperature profiles and the resulting thermal injury formation on the epiesophageal surface during radiofrequency (RF) ablation. In addition to being the first study to detail temperature profiles inclusive of the epiesophageal surface during RF ablation, we believe that the results add further concern to the use of temperature sensing technology in the quest to reduce esophageal injury. Three recent clinical trials have evaluated the efficacy of luminal esophageal temperature (LET) monitoring and found either no benefits, or signals of harm. On the other hand, two pilot RCTs suggest benefits of active cooling, and a large RCT, the IMPACT study, further confirms this benefit by finding an 83% reduction in esophageal lesion formation using an active cooling device. With no degradation in ablation efficacy, as well as a reduction/elimination of the need for fluoroscopy and reports of shortened procedure time with active cooling technology, the data of Kar et al., combined with growing clinical data, suggest that continued use of LET monitoring may be unjustified.

Peer review status:ACCEPTED

25 Feb 2021Submitted to Journal of Cardiovascular Electrophysiology
27 Feb 2021Assigned to Editor
27 Feb 2021Submission Checks Completed
28 Feb 2021Editorial Decision: Accept