Abstract
We congratulate Kar et al. on their elegant study evaluating ex-vivo
temperature profiles and the resulting thermal injury formation on the
epiesophageal surface during radiofrequency (RF) ablation. In addition
to being the first study to detail temperature profiles inclusive of the
epiesophageal surface during RF ablation, we believe that the results
add further concern to the use of temperature sensing technology in the
quest to reduce esophageal injury. Three recent clinical trials have
evaluated the efficacy of luminal esophageal temperature (LET)
monitoring and found either no benefits, or signals of harm. On the
other hand, two pilot RCTs suggest benefits of active cooling, and a
large RCT, the IMPACT study, further confirms this benefit by finding an
83% reduction in esophageal lesion formation using an active cooling
device. With no degradation in ablation efficacy, as well as a
reduction/elimination of the need for fluoroscopy and reports of
shortened procedure time with active cooling technology, the data of Kar
et al., combined with growing clinical data, suggest that continued use
of LET monitoring may be unjustified.