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Pain perception during esophageal warming due to radiofrequency catheter ablation in the left atrium
Journal of Interventional Cardiac Electrophysiology , 12/11/09

Galeazzi M et al. – Pain perception in LA ablation is significantly related to esophageal warming and is higher when the RF is delivered near the esophagus. It seems advisable to perform ET monitoring in sedated patients to avoid short– and long–term jeopardizing of the esophageal wall.

Exclusive Author Commentary
Marco Galeazzi, 12/13/09

Rising importance is given to the topic of the risk of esophageal damage in course of radiofrequency ablation of atrial fibrillation. Recent original works document either that radiofrequency delivery at the level of left atrial posterior wall is able to generate pain in conscious patients, or that the same form of energy is associated to endo-esophageal temperature rising in sedated patients. So far as is known, our work is going to be the first one taking simultaneously into account (1) the intensity of radiofrequency-related pain, (2) the exact left atrial site of radiofrequency delivery and (3) the distance between the tip of the ablator catheter and the esophagus during each radiofrequency administration in conscious patients. Our results put the accent on the importance of the symptoms reported by the patients, as regard to the possibility of incoming esophageal damage. The patients that undergo the procedure without general anaesthesia (as it happens in many centres) are often given morphine or other analgesic drugs as soon as they start complaining visceral pain. In these occasions, starting of endo-esophageal temperature recording should be strongly advisable to let the operator ultimate the procedure without risks. Indeed, the absence of the "alerting bell" represented by the patient's symptoms (that we demonstrate to be strongly, even though not exclusively, related to esophageal temperature rising) is likely to induce the physician to keep on giving energy at the level of dangerous zones. For the same reason, the insertion of an esophageal thermometer appears mandatory in anaesthetized patients.

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