Key result
Active esophageal cooling during AF ablation is linked to a 0% atrioesophageal fistula rate versus standard monitoring.
Why the study?
Active esophageal cooling reduces severe esophageal lesions during AF ablation, but a formal analysis of the atrioesophageal fistula rate had not previously been performed.
Does active esophageal cooling reduce atrioesophageal fistula rates compared to luminal esophageal temperature monitoring in patients undergoing radiofrequency ablation for atrial fibrillation?
Cohort (n=25,186)
Yes
Does active esophageal cooling reduce atrioesophageal fistula rates compared to luminal esophageal temperature monitoring in patients undergoing radiofrequency ablation for atrial fibrillation?
Absolute Event Rate: 0% vs 0.146%
p-value: p=< 0.0001
Adoption of active esophageal cooling during radiofrequency ablation for atrial fibrillation is associated with a significant reduction in the risk of atrioesophageal fistula compared to standard luminal temperature monitoring.
Esophageal cooling was associated with lower AEF rates; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. OBJECTIVES: The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. METHODS: This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. RESULTS: A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001). CONCLUSIONS: Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.
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Sánchez et al. (2023) conducted a cohort in Atrial fibrillation (n=25,186). Active esophageal cooling vs. Luminal esophageal temperature (LET) monitoring was evaluated on Atrioesophageal fistula (AEF) rate (p=< 0.0001). Active esophageal cooling during radiofrequency ablation for atrial fibrillation was associated with a 0% atrioesophageal fistula rate compared to 0.146% with standard monitoring (P<0.0001).
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