reduced-procedure-time-variability-with-active-esophageal-cooling

Reduced Procedure Time and Variability with Active Esophageal Cooling During Radiofrequency Ablation for Atrial Fibrillation

Various methods are utilized during radiofrequency (RF) pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) to protect the ...

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University of Texas Southwestern Medical Center

Active esophageal cooling is increasingly utilized as an alternative to luminal esophageal temperature (LET) monitoring for protection against thermal injury during pulmonary vein isolation (PVI) when treating atrial fibrillation (AF). Published data demonstrate the efficacy of active cooling in reducing thermal injury, but impacts on procedural efficiency are not as well characterized. LET monitoring compels pauses in ablation due to heat stacking and temperature overheating alarms that in turn delay progress of the PVI procedure, whereas active esophageal cooling allows avoidance of this phenomenon. Our objective was to measure the change in PVI procedure duration after implementation of active esophageal cooling as a protective measure against esophageal injury.

Procedural time reduction associated with active esophageal cooling during pulmonary vein isolation.

Although specific temperature targets are debated, targeted temperature management (TTM) is a common treatment for postcardiac arrest patients. However, consistently implementing a TTM protocol is challenging, especially in a community hospital. Often, the protocols described in the literature include labor- and cost-intensive methods that are not feasible or sustainable in many health care settings. Esophageal temperature management (ETM) is a TTM method that can be easily utilized alone or combined with surface methods. We sought to evaluate ETM in a cohort of patients treated with TTM after cardiac arrest. Chart reviews were conducted of all patients treated with ETM after cardiac arrest at our community medical center. Initial patient temperature, time to target, supplemental methods (water blankets, chest wraps, or head wraps), and patient survival were extracted for analysis. A total of 54 patients were treated from August 2016 to November 2018; 30 received ETM only, 22 received supplemental cooling, and 2 had treatment discontinued before reaching target due to recovery. Target temperatures ranged from 32°C to 36°C, depending on provider preference. The median time to target temperature for the entire cohort was 219 minutes (interquartile range [IQR] 81-415). For the cohorts without, and with, supplemental cooling modalities, the median time to attain target temperature was 128 minutes (IQR 71-334), and 285 minutes (IQR 204-660), respectively. Survival to intensive care unit discharge was 51.9% for the entire cohort. Survivors exhibited longer times to achieve goal temperature (median 180 minutes in nonsurvivors vs. 255 minutes in survivors). ETM attains target temperature at a rate consistent with current guidelines and with similar performance to alternative modalities. As in other studies, surviving patients required longer times to reach target temperature.

Targeted Temperature Management Using Esophageal Cooling.

Radiofrequency (RF) ablation of the left atrium of the heart is increasingly used to treat atrial fibrillation (AF). Unfortunately, inadvertent thermal injury to the esophagus can occur during this procedure, potentially creating an atrioesophageal fistula (AEF) which is 80% fatal. The ensoETM (Attune Medical, Chicago, IL), is an esophageal cooling device that has been shown to reduce thermal injury to the esophagus during RF ablation.

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

Left atrial ablation to obtain pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF) is a technologically intensive procedure utilizing innovative and continually improving technology. Changes in the technology utilized for PVI can in turn lead to changes in procedure costs. Because of the proximity of the esophagus to the posterior wall of the left atrium, various technologies have been utilized to protect against thermal injury during ablation. The impact on hospital costs during PVI ablation from utilization of different technologies for esophageal protection during ablation has not previously been evaluated.

Improved hospital discharge and cost savings with esophageal cooling during left atrial ablation.

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.

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

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. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed.

Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation.

Proactive esophageal cooling has been FDA cleared to reduce the likelihood of ablation-related esophageal injury resulting from radiofrequency (RF) cardiac ablation procedures. Data suggest that procedure times for RF pulmonary vein isolation (PVI) also decrease when proactive esophageal cooling is employed instead of luminal esophageal temperature (LET) monitoring. Reduced procedure times may allow increased electrophysiology (EP) lab throughput. We aimed to quantify the change in EP lab throughput of PVI cases after the introduction of proactive esophageal cooling.

ArticleTotal : 2	Year
Publication title Cited by 4	2022
Publication title	2026

Article	Year
Procedural time reduction associated with active esophageal cooling during pulmonary vein isolation. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing\| PubMed ID: 35416632	2022
Targeted Temperature Management Using Esophageal Cooling. Therapeutic hypothermia and temperature management\| PubMed ID: 36301260	2022
Active esophageal cooling during radiofrequency ablation of the left atrium: data review and update. Expert review of medical devices\| PubMed ID: 36413154	2022
Improved hospital discharge and cost savings with esophageal cooling during left atrial ablation. Journal of medical economics\| PubMed ID: 36537305	2023
Improved 1-year outcomes after active cooling during left atrial radiofrequency ablation. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing\| PubMed ID: 36670327	2023
Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation. JACC. Clinical electrophysiology\| PubMed ID: 37737773	2023
Association between proactive esophageal cooling and increased lab throughput. Journal of cardiovascular electrophysiology\| PubMed ID: 38566579	2024

Christopher Joseph

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