Esophageal Temperature Management with Inverse Ratio Breathing Pattern during Cryoballoon Ablation for Atrial Fibrillation.

Esophageal thermal injury is a well-recognized complication of cryoballoon ablation for atrial fibrillation. There are different methods for managing luminal esophageal temperature to prevent the development of various life-threatening complications. One of such complications is arterio-esophageal fistula with a high mortality rate. All these methods have limitations. We would like to offer a new method for managing luminal esophageal temperature during cryoballoon ablation for atrial fibrillation. The main conception of this method is in mechanical displacement of the heart relative to the esophagus during deep inhaling. Thus, we can manage cool distribution in esophageal tissues. It may help to avoid low luminal esophageal temperature which correlates with esophageal injuries. A total of 49 patients from December 2020 to June 2022 with low luminal esophageal temperature were divided into two groups. Experimental group included 34 patients who underwent inverse ratio breathing pattern. Control group included 15 patients, in which ablation was just terminated. The mean time of ablation in group 1 was 194 [±50] seconds in comparison with the group 2 - 144 [±44] seconds, p<0.001. Luminal esophageal temperature was higher in group 1 with a mean temperature of 19[±3]°С vs. 17[±3]°С, p=0.015. There were 3 esophageal injuries in group 1. All of them were erythema, but there was no statistical difference, p=0.32. No major cardiac or cerebral events were observed in both groups. The new method for managing luminal esophageal temperature with an inverse ratio breathing pattern may be useful during cryoablation for atrial fibrillation. It shows its efficacy in right inferior pulmonary vein and left atrial posterior wall. The safety profile is close to the termination ablation strategy with low luminal esophageal temperature.