Feasibility and safety of using an esophageal protective system to eliminate esophageal thermal injury: Implications on atrial-esophageal fistula following AF ablation

Mauricio S. Arruda, Luciana Armaganijan, Luigi Di Biase, Rassoll Rashidi, Andrea Natale

Research output: Contribution to journalArticle

28 Scopus citations


A Protective System to Spare the Esophagus from Thermal Injury During LA Ablation. Background: Ablation for atrial fibrillation (AF) requires energy delivery in close proximity to the esophagus (Eso) which has accounted for the LA-Eso fistula, a rare but life-threatening complication. Purpose: We evaluated an Eso cooling system to protect the Eso during RF ablation. Methods and Results: An "in vitro" heart-Eso preparation was initially used to test a temperature-controlled fluid-circulating system (EPSac [esophageal protective system] - RossHart Technologies Inc.) and an expandable compliant Eso sac during cardiac RF delivery (4 mm tip, perpendicular to the heart, 15 g pressure) at 25, 35, and 45 W, 100 ± 5 Ω for 30 seconds with the EPSac at 25, 15, 10, and 5°C. All cardiac lesions were transmural. Eso thermal injury could only be avoided with the EPSac at 10 and 5°C. The system was then tested in 6 closed chest dogs, each receiving 12 RFs (LA aiming at the Eso) for 30 seconds: without EPSac (control) at 35 W (1 dog); at 45 W with EPSac at 25°C (1 dog), 10°C (2 dogs), and 5°C (2 dogs). The EPSac volume was intentionally increased to displace the Eso toward the LA (2 dogs 5 and 10°C). Eso injured control and EPSac at 25°C; Eso spared EPSac at 5 and 10°C, without Eso displacement. Shallow external Eso injury noted when intentionally displacing the Eso toward the LA. Conclusions: The EPSac spares the Eso from collateral thermal injury. It requires circulating fluid at 5 or 10°C and a compliant sac to avoid displacement of the Eso. Its safety and efficacy remain to be demonstrated in patients undergoing AF ablation.

Original languageEnglish (US)
Pages (from-to)1272-1278
Number of pages7
JournalJournal of cardiovascular electrophysiology
Issue number11
StatePublished - Nov 2009
Externally publishedYes



  • Atrial fibrillation
  • Atrioesophageal fistula
  • Catheter ablation
  • Pulmonary vein isolation
  • Treatment of atrial fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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