Background: Atrial fibrillation (AF) is the most frequent supraventricular tachyarrhythmia in clinical practice. Catheter ablation of these arrhythmias has been indicated for reccurrent and symptomatic episodes. Atrioesophageal fistula is a rare and seriously complication of the left atrium ablation. The monitoring of the esophageal temperature has allowed to reduce the incidence of this serious complication by withdrawing or titration of energy supply in the posterior wall of the left atrium.
Case Report: 72 year old female was referred to catheter ablation due to symptomatic and amiodarone refractory paroxysmal AF. She had a CHA2DS2VASc score = 3 and the INR value of 2,3. The procedure was performed under general anesthesia and using the multipolar circular ablation catheter (PVAC, Medtronic). Temperature monitoring underwent with multielectrode lead inserted in the distal portion of esophagus. After single venous femoral access, heparin was administrated (100U/kg) with ACT target of >350s. Noncomplicated transeptal puncture was perfomed guided by fluoroscopy and intracardiac ECHO. Pulmonar vein isolation was achieved using bipolar energy offer in the antrum of the each vein (n=4). During ablation on left superior PV, there was elevation of Eso temperature (35,7 to 38,5C). Complete isolation of these vein was achieved reducing of energy offer (2:1 to 4:1) in the electrode par of the PVAC catheter without rise of Eso temperature.
Conclusions: Multipolar PVAC catheter allowed safety pulmonary vein isolation using titration energy offer guided esophageal temperature control.