Key result
Active esophageal cooling is linked to ~20-minute shorter RF PVI procedures vs LET monitoring.
Why the study?
Active esophageal cooling is increasingly used over luminal esophageal temperature monitoring during RF PVI for AF, but how these approaches influence procedure times and variability was unclear.
Does active esophageal cooling reduce procedure time and variability compared to traditional luminal esophageal temperature monitoring in patients undergoing radiofrequency ablation for atrial fibrillation?
Observational (n=164)
Does active esophageal cooling reduce procedure time and variability compared to traditional luminal esophageal temperature monitoring in patients undergoing radiofrequency ablation for atrial fibrillation?
Active esophageal cooling during radiofrequency pulmonary vein isolation for atrial fibrillation significantly reduces procedure time and its variability compared to traditional luminal esophageal temperature monitoring.
Active esophageal cooling may alter AF ablation times and variability; leaves open optimal esophageal protection without randomized outcome data.
Various methods are utilized during radiofrequency (RF) pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) to protect the esophagus from inadvertent thermal injury. Active esophageal cooling is increasingly being used over traditional luminal esophageal temperature (LET) monitoring, and each approach may influence procedure times and the variability around those times. The objective of this study is to measure the effects on procedure time and variability in procedure time of two different esophageal protection strategies utilizing advanced informatics techniques to facilitate data extraction. Trained clinical informaticists first performed a contextual inquiry in the catheterization laboratory to determine laboratory workflows and observe the documentation of procedural data within the electronic health record (EHR). These EHR data structures were then identified in the electronic health record reporting database, facilitating data extraction from the EHR. A manual chart review using a REDCap database created for the study was then performed to identify additional data elements, including the type of esophageal protection used. Procedure duration was then compared using summary statistics and standard measures of dispersion. A total of 164 patients underwent radiofrequency PVI over the study timeframe; 63 patients (38%) were treated with LET monitoring, and 101 patients (62%) were treated with active esophageal cooling. The mean procedure time was 176 min (SD of 52 min) in the LET monitoring group compared to 156 min (SD of 40 min) in the esophageal cooling group (P = 0.012). Thus, active esophageal cooling during PVI is associated with reduced procedure time and reduced variation in procedure time when compared to traditional LET monitoring.
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Joseph et al. (2022) conducted an observational in atrial fibrillation (n=164). Active esophageal cooling vs. Luminal esophageal temperature (LET) monitoring was evaluated on Procedure time (p=0.012). Active esophageal cooling during radiofrequency pulmonary vein isolation was associated with a reduced mean procedure time compared to traditional LET monitoring (156 vs 176 minutes; P=0.012).
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