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

Javier Sanchez; Christopher Woods; Jason Zagrodzky; Jose Nazari; Matthew J. Singleton; Amir Schricker; Annie Ruppert; Babette Brumback; Benjamin Jenny; Charles Athill; Christopher Joseph; Dipak Shah; Gaurav Upadhyay; Erik Kulstad; John Cogan; Jordan Leyton-Mange; Julie Cooper; Kamala Tamirisa; Samuel Omotoye; Saroj Timilsina; Alejandro Perez-Verdia; Andrew Kaplan; Apoor Patel; Alex Ro; Andrew Corsello; Arun Kolli; Brian Greet; Danya Willms; David Burkland; Demetrio Castillo; Firas Zahwe; Hemal Nayak; James Daniels; John MacGregor; Matthew Sackett; W. Michael Kutayli; Michel Barakat; Robert Percell; Spyridon Akrivakis; Steven C. Hao; Taylor Liu; Ambrose Panico; Archana Ramireddy; Thomas Dewland; Edward P. Gerstenfeld; Daniel Benhayon Lanes; Edward Sze; Gregory Francisco; Jose Silva; Julia McHugh; Kai Sung; Leon Feldman; Nicholas Serafini; Raymond Kawasaki; Richard Hongo; Richard Kuk; Robert Hayward; Shirley Park; Andrew Vu; Christopher Henry; Shane Bailey; Steven Mickelsen; Taresh Taneja; Westby Fisher; Mark Metzl

doi:10.1016/j.jacep.2023.08.022

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

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

Javier Sanchez, Christopher Woods, Jason Zagrodzky, Jose Nazari, Matthew J. Singleton, Amir Schricker, Annie Ruppert, Babette Brumback, Benjamin Jenny, Charles Athill, …

JACC. Clinical electrophysiology, Vol.9(12), pp.2558-2570

12/2023

DOI: 10.1016/j.jacep.2023.08.022

PMID: 37737773

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Abstract

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. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. Objectives The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. Methods This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. Results A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001). Conclusions 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.

Details

Title: Subtitle: Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation
Creators: Javier Sanchez - Texas Cardiac Arrhythmia
Christopher Woods
Jason Zagrodzky - Texas Cardiac Arrhythmia
Jose Nazari - NorthShore University HealthSystem
Matthew J. Singleton - WellSpan Health
Amir Schricker - Mills Peninsula Health Services
Annie Ruppert - Sharp Memorial Hospital
Babette Brumback - University of Florida
Benjamin Jenny - Tri-City Medical Center
Charles Athill - San Diego Cardiac Center
Christopher Joseph - The University of Texas Southwestern Medical Center
Dipak Shah - Ascension
Gaurav Upadhyay - University of Chicago
Erik Kulstad - The University of Texas Southwestern Medical Center
John Cogan - Memorial Healthcare System
Jordan Leyton-Mange
Julie Cooper - The University of Texas Southwestern Medical Center
Kamala Tamirisa - Texas Cardiac Arrhythmia
Samuel Omotoye - Cleveland Clinic
Saroj Timilsina - Memorial Healthcare System
Alejandro Perez-Verdia
Andrew Kaplan
Apoor Patel
Alex Ro - Memorial Healthcare System
Andrew Corsello
Arun Kolli
Brian Greet
Danya Willms
David Burkland
Demetrio Castillo
Firas Zahwe
Hemal Nayak
James Daniels
John MacGregor - Memorial Healthcare System
Matthew Sackett - WellSpan Health
W. Michael Kutayli
Michel Barakat
Robert Percell
Spyridon Akrivakis
Steven C. Hao
Taylor Liu
Ambrose Panico
Archana Ramireddy
Thomas Dewland
Edward P. Gerstenfeld
Daniel Benhayon Lanes
Edward Sze
Gregory Francisco
Jose Silva
Julia McHugh
Kai Sung
Leon Feldman
Nicholas Serafini
Raymond Kawasaki
Richard Hongo
Richard Kuk
Robert Hayward
Shirley Park
Andrew Vu - University of Chicago
Christopher Henry - The University of Texas Southwestern Medical Center
Shane Bailey
Steven Mickelsen
Taresh Taneja
Westby Fisher
Mark Metzl
Resource Type: Journal article
Publication Details: JACC. Clinical electrophysiology, Vol.9(12), pp.2558-2570
DOI: 10.1016/j.jacep.2023.08.022
PMID: 37737773
NLM abbreviation: JACC Clin Electrophysiol
ISSN: 2405-500X
eISSN: 2405-5018
Grant note: DOI: 10.13039/100000050, name: NHLBI
Language: English
Electronic publication date: 09/2023
Date published: 12/2023
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984472532702771

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