Why the study?
Active esophageal cooling reduces thermal injury risk during AF ablation but may not reduce GERD symptoms, and factors associated with post-ablation GERD and chest pain despite cooling remain unclear.
Population
295 participants undergoing RFA with esophageal cooling for paroxysmal or persistent AF
Comparison
Participants with vs without post-ablation GERD and chest pain
Design
Observational questionnaire-based study
Follow-up
7–14 days post-procedure
Key result
Among patients undergoing AF ablation with esophageal cooling, post-ablation chest pain occurred in 24.1% and was less common when bilateral first-pass isolation was achieved (59.2% vs 72.6%, p=0.033).
Authors
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This evaluation will help us confirm the benefits of oesophageal cooling beyond safety alone, including shorter procedure times, reduced fluoroscopy requirements, greater hospital savings, and improved long-term freedom from arrhythmia.”
“Our lab has published studies showing a 30% reduction in procedure time and a 14% improvement in long-term efficacy when using ensoETM. This important multicentre study will help us to further quantify effects in a wider range of practice across the USA.”
“I've been using proactive oesophageal cooling for over two years now, and have been quite pleased with the safety and procedural efficiency that it offers, which in turn has increased our lab throughput to enable the treatment of more patients. I expect this new study will further quantify our experience.”
Post-ablation chest pain remains common despite esophageal cooling; leaves open whether bilateral first-pass isolation reduces symptoms pending prospective trials.
Observational (n=295)
Despite active esophageal cooling during AF ablation, post-procedural chest pain and GERD remain common and are associated with specific patient and procedural factors such as younger age and lack of bilateral first-pass isolation.
Silverstein et al. (2026) conducted an observational in Atrial fibrillation (n=295). Radiofrequency ablation with active esophageal cooling was evaluated on Post-ablation GERD (GERDQ score ≥ 8) and chest pain. Among patients undergoing AF ablation with esophageal cooling, post-ablation chest pain occurred in 24.1% and was less common when bilateral first-pass isolation was achieved (59.2% vs 72.6%, p=0.033).
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