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Published in: Journal of Interventional Cardiac Electrophysiology 7/2023

Open Access 21-01-2023 | Atrial Fibrillation

Improved 1-year outcomes after active cooling during left atrial radiofrequency ablation

Authors: Christopher Joseph, Jose Nazari, Jason Zagrodzky, Babette Brumback, Jacob Sherman, William Zagrodzky, Shane Bailey, Erik Kulstad, Mark Metzl

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 7/2023

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Abstract

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 1-year arrhythmia recurrence rates between patients treated with luminal esophageal temperature (LET) monitoring versus active esophageal cooling during left atrial ablation.

Method

Data from two healthcare systems (including 3 hospitals and 4 electrophysiologists) were reviewed for patient rhythm status at 1-year follow-up after receiving PVI for the treatment of AF. Results were compared between patients receiving active esophageal cooling (ensoETM, Attune Medical, Chicago, IL) 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. The 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 1-year follow-up, KM estimates for freedom from AF were 58.2% for LET-monitored patients and 72.2% for actively cooled patients, for an absolute increase in freedom from AF of 14% with active esophageal cooling (p = .03). Adjustment for the confounders of patient age, gender, type of AF, and operator with an inverse probability of treatment weighted Cox proportional hazards model yielded a hazard ratio of 0.6 for the effect of cooling on AF recurrence (p = 0.045).

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 1 year was found in patients treated with active esophageal cooling when compared to patients who received LET monitoring. More rigorous prospective studies or randomized studies are required to validate the findings of the current study.
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Metadata
Title
Improved 1-year outcomes after active cooling during left atrial radiofrequency ablation
Authors
Christopher Joseph
Jose Nazari
Jason Zagrodzky
Babette Brumback
Jacob Sherman
William Zagrodzky
Shane Bailey
Erik Kulstad
Mark Metzl
Publication date
21-01-2023
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 7/2023
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-023-01474-3

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