A Pilot Study of an Esophageal Cooling Device During Radiofrequency Ablation for Atrial Fibrillation

Background Esophageal thermal injury is a risk of ablation of the posterior left atrium despite various devices utilized to date. Objective Evaluate the potential of a commercially-available esophageal cooling device to provide esophageal protection during left atrial catheter ablation. Methods In this pilot study, we randomized 6 patients undergoing catheter ablation for atrial fibrillation. Three patients received standard of care for our site (use of a single-sensor temperature probe, with adjunct iced-water instillation for any temperature increases >1°C). Three patients received standard ablation after placement of the esophageal cooling device using a circulating water temperature of 4°C. All patients underwent transesophageal echocardiogram (TEE) and esophagogastroduodenoscopy (EGD) on the day prior to ablation followed by EGD on the day after. Results In the 3 control patients, one had no evidence of esophageal mucosal damage, one had diffuse sloughing of the esophageal mucosa and multiple ulcerations, and one had a superficial ulcer with large clot. Both patients with lesions were classified as Zargar 2a. In the 3 patients treated with the cooling device, one had no evidence of esophageal mucosal damage, one had esophageal erythema (Zargar 1), and one had a solitary Zargar 2a lesion. At 3-month follow-up, 1 patient in each group had recurrence of atrial fibrillation. Conclusions The extent of esophageal injury was less severe with a commercially available esophageal cooling device than with reactive instillation of ice-cold water. This pilot study supports further evaluation with a larger clinical trial.