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November 1, 2022Journal of Innovations in Cardiac Rhythm ManagementOpen Access

Proactive esophageal cooling cuts grade 2a lesions by ~50% versus reactive cooling during AF ablation.

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Why the study?

Esophageal thermal injury remains a major risk during posterior left atrial ablation, and whether a dedicated proactive esophageal cooling device is feasible and comparable to standard luminal esophageal temperature monitoring with reactive cold-water instillation was unstudied.

Does proactive esophageal cooling using a dedicated device reduce esophageal mucosal damage compared to reactive cooling in patients undergoing catheter ablation for atrial fibrillation?

Population

6 patients undergoing catheter ablation for AF

Comparison

Dedicated esophageal cooling device vs standard LET monitoring with reactive cold-water instillation

Design

Randomized study

Follow-up

3 months

Key result

Proactive esophageal cooling during atrial fibrillation ablation resulted in 1 of 3 patients developing a grade 2a lesion, compared to 2 of 3 patients receiving reactive cooling.

Authors

BCBrad ClarkNANazia AlviJHJoseph Hanks

Discussion

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Member takes

Overview

Proactive cooling may reduce esophageal injury in AF ablation; extends feasibility data and supports larger confirmatory RCTs.

Study Design

Type

RCT (n=6)

Randomization

randomized

Multicenter

No

Structured PICO

Does proactive esophageal cooling using a dedicated device reduce esophageal mucosal damage compared to reactive cooling in patients undergoing catheter ablation for atrial fibrillation?

P
Population
6 patients undergoing catheter ablation for atrial fibrillation, evaluated for esophageal injury 1 day post-ablation and followed for 3 months.
I
Intervention
Proactive esophageal cooling via a dedicated esophageal cooling device at a circulating water temperature of 4°C, without the use of any esophageal temperature monitoring
C
Comparator
Standard luminal esophageal temperature (LET) monitoring with reactive cooling via manual cold-water instillation (use of a single-sensor temperature probe, with adjunct ice-water instillation for any temperature increases of >1°C)
O
Outcome
Esophageal mucosal damage assessed by esophagogastroduodenoscopy the day after the ablationsafety

Proactive esophageal cooling using a dedicated device is feasible during atrial fibrillation ablation and provides a basis for further investigation into its efficacy for esophageal protection compared to reactive cooling.

Cite This Study

Clark et al. (2022) conducted an RCT in Atrial fibrillation (n=6). Proactive esophageal cooling device vs. Standard luminal esophageal temperature monitoring with reactive cold-water instillation was evaluated on Esophageal mucosal damage assessed by esophagogastroduodenoscopy. Proactive esophageal cooling during atrial fibrillation ablation resulted in 1 of 3 patients developing a grade 2a lesion, compared to 2 of 3 patients receiving reactive cooling.

synapsesocial.com/papers/6aa25e484f988c8b52139e8fhttps://doi.org/10.19102/icrm.2022.13111
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