Active esophageal cooling during radiofrequency ablation of the left atrium: data review and update

Cooper, Julie; Joseph, Christopher; Zagrodzky, Jason; Woods, Christopher; Metzl, Mark; Turer, Robert W; McDonald, Samuel A.; Kulstad, Erik; Daniels, James

doi:10.1080/17434440.2022.2150930

Cited by 8 publications

(8 citation statements)

References 77 publications

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“…[43,44] To date, no AEF has yet been identified in a patient treated with active esophageal cooling using a dedicated esophageal cooling device, and only a single pericardio-esophageal fistula has been reported despite over 22,000 RF catheter ablations now completed using this cooling device. [45] Pericardio-esophageal fistula is a rare, and less severe, subset of fistula formation. [46] Analysis of this event suggests higher total energy was deposited over the esophagus than is typical, with higher ablation index targets on the posterior wall than the commonly used 380-400 units, and lesions stacked near the esophagus, which has recently been suggested to increase risk of injury.…”

Section: Discussionmentioning

confidence: 99%

Multicenter analysis of atrioesophageal fistula rates before and after adoption of active esophageal cooling during atrial fibrillation ablation

Sánchez

Woods²,

Zagrodzky³

et al. 2023

Preprint

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Background: Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. No atrioesophageal fistula (AEF) has been reported to date with active esophageal cooling, and only one pericardio-esophageal fistula has been reported; however, a formal analysis of the AEF rate with active esophageal cooling has not previously been performed. Methods: Atrial fibrillation ablation procedure volumes before and after adoption of active cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were determined across 25 hospital systems with the highest total use of esophageal cooling during RF ablation. The number of AEFs occurring in equivalent time frames before and after adoption of cooling were then determined, and AEF rates were compared using generalized estimating equations robust to cluster correlation. Results: Throughout the 25 hospital systems, which included a total of 30 separate hospitals, 14,224 patients received active esophageal cooling during RF ablation, with the earliest adoption beginning in March 2019 and the most recent beginning in March 2022. In the time frames prior to adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In this pre-adoption cohort a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates of <0.1% to 0.25%. No AEFs were found in the cohort treated after adoption of active esophageal cooling, yielding an AEF rate of 0% (P<0.0001). Conclusion: Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.

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Section: Discussionmentioning

confidence: 99%

Multicenter analysis of atrioesophageal fistula rates before and after adoption of active esophageal cooling during atrial fibrillation ablation

Sánchez

Woods²,

Zagrodzky³

et al. 2023

Preprint

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“…8,[11][12][13][14][15][16] In addition to significant safety improvements, a variety of other benefits have been reported including a reduction in fluoroscopy requirements, reduced postoperative chest pain, and increased long term procedural efficacy. 10,17,18 The cases described here suggest that utilizing proactive cooling does not disrupt the procedural flow of the hybrid convergent procedure but may simultaneously add the benefit of thermal protection. Because esophageal temperature monitoring is not required when proactive esophageal cooling is employed, premature discontinuation of energy delivery did not occur in any of the cases.…”

Section: Discussionmentioning

confidence: 93%

Hybrid Convergent Procedure with Proactive Esophageal Cooling for the Treatment of Long-Standing Persistent Atrial Fibrillation

Zagrodzky,

Velasco,

Buch

et al. 2024

Preprint

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The hybrid Convergent procedure is approved to treat symptomatic patients with long-standing persistent atrial fibrillation (AF). Despite direct visualization during surgical ablation as well as the use of luminal esophageal temperature (LET) monitoring, esophageal injury is still possible. A dedicated device for proactive esophageal cooling has recently been cleared by the Food and Drug Administration (FDA) to reduce the likelihood of ablation-related esophageal injury resulting from radiofrequency cardiac ablation procedures. In this report, we describe the first uses of proactive esophageal cooling for esophageal protection during the epicardial ablation portion of hybrid convergent procedures.

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“… 8 , 11–16 In addition to significant safety improvements, a variety of other benefits have been reported including a reduction in fluoroscopy requirements, reduced postoperative chest pain, and increased long-term procedural efficacy. 10 , 17 , 18 This improved efficacy is believed to stem from the improved continuity index achieved when pauses and repositioning due to local overheating are eliminated. 19 …”

Section: Discussionmentioning

confidence: 99%

Hybrid convergent procedure with proactive oesophageal cooling for the treatment of long-standing persistent atrial fibrillation: a case series

Velasco,

Buch,

Hui

et al. 2024

European Heart Journal - Case Reports

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Background The hybrid convergent procedure is approved to treat symptomatic patients with long-standing persistent atrial fibrillation (AF). Despite direct visualization during surgical ablation as well as the use of luminal oesophageal temperature (LET) monitoring, oesophageal injury is still possible. A dedicated device for proactive oesophageal cooling has recently been cleared by the Food and Drug Administration to reduce the likelihood of ablation-related oesophageal injury resulting from radiofrequency cardiac ablation procedures. This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of hybrid convergent procedures. Case summary Five patients with long-standing persistent AF underwent hybrid convergent ablations with the use of proactive oesophageal cooling as means of oesophageal protection. All cases were completed successfully with no adverse effects. Most notably, cases were shorter when compared to cases using LET monitoring, likely due to lack of pauses for overheating of the oesophagus that would otherwise be required to prevent damage to the oesophagus. Discussion This report describes the first uses of proactive oesophageal cooling for oesophageal protection during the epicardial ablation portion of five hybrid convergent procedures. Use of cooling enabled uninhibited deployment of lesions without the need to pause energy delivery due to elevated temperatures in the oesophagus, providing a feasible alternative to LET monitoring.

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Active esophageal cooling during radiofrequency ablation of the left atrium: data review and update

Cited by 8 publications

References 77 publications

Multicenter analysis of atrioesophageal fistula rates before and after adoption of active esophageal cooling during atrial fibrillation ablation

Multicenter analysis of atrioesophageal fistula rates before and after adoption of active esophageal cooling during atrial fibrillation ablation

Hybrid Convergent Procedure with Proactive Esophageal Cooling for the Treatment of Long-Standing Persistent Atrial Fibrillation

Hybrid convergent procedure with proactive oesophageal cooling for the treatment of long-standing persistent atrial fibrillation: a case series

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