Procedural Time Reduction With Active Esophageal Cooling During Radiofrequency Ablation: A Multi-Operator Review

Purpose: To determine procedural times for radiofrequency (RF) ablations to obtain pulmonary vein isolation (PVI) using either active esophageal cooling or luminal esophageal temperature (LET) monitoring to protect the esophagus. Active esophageal cooling is increasingly being used to protect the esophagus during RF ablation. Recent data suggest that in addition to having safety and long-term outcome benefits, active esophageal cooling may also have procedural benefits. We therefore conducted, with multiple operators, a large analysis of procedural times.

Material and Methods: We reviewed procedural data from a high-volume electrophysiology group made up of 4 electrophysiologists operating out of a two-hospital healthcare system. All RF ablations for PVI performed from February 2020 through September 2021 were included in the review, and no patients were excluded. Procedural times were obtained from the electronic health record, and results were compared to published historical data from this same group for ablations using LET monitoring.

Results: A total of 560 patients were treated with active esophageal cooling over the study time frame. Mean and median procedure duration was 100 minutes (SD 46 minutes) and 95 minutes (interquartile range 69 to 123 minutes), respectively. This compares to LET mean and median procedure times of 146 minutes (SD 51 minutes) and 141 minutes (interquartile range 104 to 174 minutes), respectively (p < 0.001).

Conclusions: Active esophageal cooling during RF ablation is associated with significantly reduced procedure duration compared to procedures using LET monitoring.