Significant procedure length reduction when utilizing active esophageal cooling – a six-year single center study

Abstract Background A number of factors can influence procedure duration of left atrial ablation for the treatment of atrial fibrillation (AF). In addition to ablation techniques, the use of auxiliary tools such as intraoperative fluoroscopy and luminal esophageal temperature (LET) monitoring may impact procedure duration. However, unlike recent trends toward zero-fluoroscopy procedures, there has not been a widespread transition to alternative means of esophageal protection. Multi sensor LET monitoring leads to frequent pauses during ablations when dangerous esophageal temperatures have been reached. Although an increased risk of esophageal injury when utilizing LET monitoring as compared to active esophageal cooling has been suggested in recent studies, the degree to which LET monitoring impacts procedure duration has not been well documented. Consequently, we aimed to compare procedure duration in a large single center before and after active esophageal cooling was implemented in place of LET monitoring. Objective Review procedural timing data at a single large hospital before and after the implementation of active esophageal cooling in place of LET monitoring, and compare differences in procedure duration. Methods Using an existing hospital registry of ablation procedures, we obtained procedure durations for left atrial ablations for AF before and after the implementation of active esophageal cooling into the hospital protocol. Data was collected with IRB approval from a single hospital from January 2015 through November 2021. Prior to September 2018, multi-sensor LET monitoring was utilized in all patients, whereas all patients afterwards were treated with active esophageal cooling. Results Data was analyzed from a total of 412 patients. LET monitoring was utilized with 176 patients, while active esophageal cooling was utilized with 236 patients. In the LET monitored group the median procedure length was 191 minutes with an interquartile range (IQR) of 91 minutes. In the actively cooled group, the median procedure length was 147 minutes with an IQR of 61 minutes. This represents a median difference of 44 minutes, or 23% of total procedure time (p<0.001). Conclusion When compared to LET monitoring, the use of active esophageal cooling is associated with a significant time savings in PVI procedures. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Attune Medical