Key result
Active esophageal cooling during radiofrequency ablation for atrial fibrillation significantly reduced the atrioesophageal fistula rate to 0% compared to 0.146% with standard monitoring.
Why the study?
Active esophageal cooling reduces severe esophageal lesions during AF catheter ablation, but a formal analysis of atrioesophageal fistula rates with this technique had not been performed.
Does active esophageal cooling reduce atrioesophageal fistula rates in patients undergoing radiofrequency catheter ablation for atrial fibrillation?
Cohort (n=25,186)
Yes
Does active esophageal cooling reduce atrioesophageal fistula rates in patients undergoing radiofrequency catheter ablation for atrial fibrillation?
The adoption of active esophageal cooling during radiofrequency ablation for atrial fibrillation was associated with a significant reduction in the rate of atrioesophageal fistulas.
May support esophageal cooling to prevent atrioesophageal fistula; leaves open 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. No atrioesophageal fistula (AEF) has been reported to date with active esophageal cooling, and only one pericardio-esophageal fistula has been reported; however, a formal analysis of the AEF rate with active esophageal cooling has not previously been performed. Methods Atrial fibrillation ablation procedure volumes before and after adoption of active cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were determined across 25 hospital systems with the highest total use of esophageal cooling during RF ablation. The number of AEFs occurring in equivalent time frames before and after adoption of cooling were then determined, and AEF rates were compared using generalized estimating equations robust to cluster correlation. Results Throughout the 25 hospital systems, which included a total of 30 separate hospitals, 14,224 patients received active esophageal cooling during RF ablation, with the earliest adoption beginning in March 2019 and the most recent beginning in March 2022. In the time frames prior to adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In this pre-adoption cohort a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates of <0.1% to 0.25%. No AEFs were found in the cohort treated after adoption of active esophageal cooling, yielding an AEF rate of 0% (P<0.0001). Conclusion 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 significantly reduced the atrioesophageal fistula rate to 0% compared to 0.146% with standard monitoring.
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