Determination of the relationship between the esophagus temperature and the esophagus motility in the patients applied for cryoblation due to atrial fibrillation

Aim: Pulmonary vein isolation by cryoablation is widely used today for atrial fibrillation therapy. Although cryoablation is less complicated than other ablation methods, some serious complications can be observed. Periesophageal vagal plexus injury is a complication of cryoablation. However, the effect of this damage on esophageal function is unknown. It is also known that the temperature of the esophagus decreases during the cryoablation process. The aim of this study is to investigate the effect of cryoablation on esophageal functions and to determine the relationship between esophageal temperature and esophageal motility. Materials and Methods: Twenty patients with symptomatic paroxysmal atrial fibrillation who underwent cryoablation despite at least one class I or class III antiarrhythmic drugs were included. During cryoablation, the lowest cryoballoon temperature for each pulmonary vein, the duration of freezing, and the esophageal distance fluoroscopically were estimated and recorded. With this data, the effective cold exposure for each pulmonary vein is calculated. During the procedure, the esophageal temperature was measured and recorded with the esophageal probe for each pulmonary vein isolation. Esophageal manometry was performed before the procedure and one day after the procedure for each patients in order to assess esophageal motility. A symptom questionnaire for gastrointestinal complaints was made before the procedure and 72 hours after the procedure by phone call for each patients. Results: During the procedure, the highest esophageal temperature change was found in the left side pulmonary veins in 13 patients (65 %) and in the right side pulmonary veins in 7 patients (35 %). It was found that the change of the esophagus temperature was higher on the side where the effective cold exposure was higher (p = 0.024). While there was a positive, weak and borderline correlation between the lowest cryoballoon temperature and esophagus temperature change (r: 0.22, p=0.05), there was no correlation between effective cold exposure and esophageal temperature change (r:-0.16, p=0.17). It was detected that lower esophageal sphincter pressure and esophageal contraction amplitude pressure decreased after the procedure (respectively p=0.001, p=0.005). Five (25 %) patients had newly developed gastrointestinal symptoms after the procedure. It was found that the cumulative effective cold exposure values of the new symptom-developing patients [-85.767 ± 7.806 °C.sn] were higher than those of the new symptom-free patients [-72.783 ± 14.812 °C.sn](p=0.081). Conclusion: During cryoablation, esophageal temperature measurement can be performed to reduce esophageal injury. Esophageal motility is affected after cryoablation and esophageal manometry might be performed to detect the disorder in the patient's esophageal motility with gastrointestinal symptoms. The cryoablation procedure might be considered as a whole and the rate of post-procedural complication might be predicted by calculating the cumulative effective cold exposure on the patients. When isolating pulmonary veins on the left side, the ablation duration should not be kept too high and to prevent esophageal injury unnecessary applications should not be done.