Improved One-year Outcomes After Active Cooling During Left Atrial Radiofrequency Ablation

Background: Active esophageal cooling during pulmonary vein isolation (PVI) with radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF) is increasingly being utilized to reduce esophageal injury and atrioesophageal fistula formation. Randomized controlled data also show trends towards increased freedom from AF when using active cooling. This study aimed to compare one-year arrhythmia recurrence rates between patients treated with luminal esophageal temperature (LET) monitoring versus active esophageal cooling during left atrial ablation.Methods: Data from two healthcare systems (including 3 hospitals and 4 electrophysiologists) were reviewed for patient rhythm status at one-year follow up after receiving PVI for the treatment of AF. Results were compared between patients receiving active esophageal cooling and those treated with traditional LET monitoring using Kaplan-Meier estimates.Results: A total of 513 patients were reviewed; 253 received LET monitoring using either single or multi-sensor temperature probes, and 260 received active cooling. Mean age was 66.8 (SD +/-10) years, and 36.8% were female. Arrhythmias were 60.1% paroxysmal AF, 34.3% persistent AF, and 5.6% long-standing persistent AF, with no significant difference between groups. At one-year follow-up, KM estimates for freedom from AF were 58.2% for LET monitored patients and 72.2% for actively cooled patients, for absolute increase in freedom from AF of 14% with active esophageal cooling (P=.03).Conclusions: In this first study to date of the association between esophageal protection strategy and long-term efficacy of left atrial RF ablation, a clinically and statistically significant improvement in freedom from atrial arrhythmia at one-year was found in patients treated with active esophageal cooling when compared to patients that received LET monitoring.