Unexpected High Incidence of Esophageal Injury Following Pulmonary Vein Isolation Using Robotic Navigation

Esophageal Injury Following Robotic Navigation . Introduction: Robotic navigation (RN) is a novel technology for pulmonary vein isolation (PVI). We investigated the incidence of thermal esophageal injury using RN with commonly used power settings in comparison to manual PVI procedures. Methods: Thirty‐nine patients underwent circumferential PVI using a 3.5‐mm irrigated‐tip‐catheter. In the manual (n = 25) and the RN₁ group (n = 4) power was limited to 30 W (17 mL/min flow, maximal temperature 43°C, max. 30 sec/spot) at the posterior left atrial (LA) wall. In RN‐based procedures, ablation was performed with a contact force of 10–40 g. The operator was blinded to the esophageal temperature (T_eso). In the RN₂ group ablation power along the posterior LA wall was reduced to 20 W and ablation terminated at T_eso of 41°C. Endoscopy was carried out 2 days postablation. Results: PVI was achieved in all patients. In the manual group no esophageal lesions, minimal lesions, or ulcerations were found in 15 of 25 (60%), 7 of 25 (28%), and 3 of 25 (12%) patients, respectively. All patients in the RN₁ group had an ulceration and one developed esophageal perforation. A covered stent was placed 14 days post‐PVI and removed at day 81. In the RN₂ group, only a single minimal lesion was found. Conclusions: A high incidence of thermal esophageal injury including a perforation was noted following robotic PVI using 30 W along the posterior LA wall. During RN‐based PVI procedures esophageal temperature monitoring is advocated. Reduction of ablation power to 20 W and termination of energy delivery at T_eso of 41°C significantly reduced the risk of esophageal injury. (J Cardiovasc Electrophysiol, Vol. 21, pp. 853‐858, August 2010)