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

Joseph, Christopher; Cooper, Julie; Sikka, Rishi; Zagrodzky, Jason; Turer, Robert W; McDonald, Samuel A.; Kulstad, Erik; Daniels, James

doi:10.1080/13696998.2022.2160596

Cited by 5 publications

(5 citation statements)

References 42 publications

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“…Placement of the device is analogous to that of the standard orogastric tube which it replaces, and no repositioning is required once the device is confirmed to be in proper place by either fluoroscopy or intracardiac echocardiography. Because of the insulating effect of the layers of the fibrous pericardium, serous fluid layer, and pericardial fat, no degradation in transmurality is seen on the intended lesions placed in the left atrium 18,19 …”

Section: Resultsmentioning

confidence: 99%

“…Increased EP lab throughput via the adoption of proactive esophageal cooling may facilitate reduction of patient backlog. 6,18 Improving throughput can lead to shorter patient wait times between scheduling and receiving treatment, an important aspect of reducing morbidity and risk of developing more persistent atrial fibrillation associated with delay in receiving care. 21 By reducing wait time, patient outcomes may therefore improve.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16] Shorter procedures may help improve patient safety by minimizing the additional risk that comes with prolonged time under anesthesia 17 and may also allow more procedures to be completed. 18 Although proactive esophageal cooling reduces procedure duration, its potential influence on EP lab throughput has not been examined. This study aimed to quantify the change in EP lab throughput of PVI cases following the introduction of proactive esophageal cooling using a dedicated esophageal cooling device across three different EP groups.…”

Section: Introductionmentioning

confidence: 99%

“…For example, beyond the reduction in ablation‐related esophageal injury, adoption of cooling has been associated with significantly reduced procedural duration, improved long‐term outcome, and a reduction in fluoroscopy requirements when compared to PVI ablations performed under luminal esophageal temperature (LET) monitoring 9–16 . Shorter procedures may help improve patient safety by minimizing the additional risk that comes with prolonged time under anesthesia 17 and may also allow more procedures to be completed 18 …”

Section: Introductionmentioning

confidence: 99%

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Association between proactive esophageal cooling and increased lab throughput

Zagrodzky,

Cooper,

Joseph

et al. 2024

Cardiovasc electrophysiol

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IntroductionProactive 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.MethodsEP lab throughput data were obtained from three EP groups. We then compared EP lab throughput over equal time frames at each site before (pre‐adoption) and after (post‐adoption) the adoption of proactive esophageal cooling.ResultsOver the time frame of the study, a total of 2498 PVIs were performed over a combined 74 months, with cooling adopted in September 2021, November 2021, and March 2022 at each respective site. In the pre‐adoption time frame, 1026 PVIs were performed using a combination of LET monitoring with the addition of esophageal deviation when deemed necessary by the operator. In the post‐adoption time frame, 1472 PVIs were performed using exclusively proactive esophageal cooling, representing a mean 43% increase in throughput (p < .0001), despite the loss of two operators during the post‐adoption time frame.ConclusionAdoption of proactive esophageal cooling during PVI ablation procedures is associated with a significant increase in EP lab throughput, even after a reduction in total number of operating physicians in the post‐adoption group.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between proactive esophageal cooling and increased lab throughput

Zagrodzky,

Cooper,

Joseph

et al. 2024

Cardiovasc electrophysiol

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“…Different methods have been proposed for this purpose which broadly may be considered ‘reactive’ (apply in response to an elevated oesophageal temperature) or ‘proactive’ cooling (pre-emptively cool prior to any risk of thermal injury). 35 Reduced procedure time, 36 fluoroscopy, 37 and overall cost 38 and no reduction in ablation efficacy, efficiency, and safety 39 were some of the benefits highlighted for dedicated active cooling devices. In turn, a recent systematic review and meta-analysis found that oesophageal cooling did not reduce the overall risk of any oesophageal injury compared to control.…”

Section: Strategies To Target the Spb By Percutaneous Radiofrequency ...mentioning

confidence: 99%

How to ablate the septo-pulmonary bundle: a case-based review of percutaneous ablation strategies to achieve roof line block

Tonko,

Silberbauer,

Mann

2023

Europace

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Electrical conduction through cardiac muscle fibres separated from the main myocardial wall by layers of interposed adipose tissue are notoriously difficult to target by endocardial ablation alone. They are a recognised important cause for procedural failure due to the difficulties of delivering sufficient energy via the endocardial radiofrequency catheter to reach the outer epicardial layer without risking adverse events of the otherwise thin walled atria. Left atrial ablations for atrial fibrillation (AF) and tachycardia are commonly affected by the presence of several epicardial structures, with the septo-pulmonary bundle (SPB), Bachmann’s bundle, and the ligament of Marshall all posing substantial challenges for endocardial procedures. Delivery of a transmural lesion set is essential for sustained pulmonary vein isolation and for conduction block across linear atrial lines which in turn has been described to translate into a reduced AF/atrial tachycardia recurrence rate. To overcome the limitations of endocardial-only approaches, surgical ablation techniques for epicardial or combined hybrid endo-epicardial ablations have been described to successfully target these connections. Yet, these techniques confer an increase in procedure complexity, duration, cost, and morbidity. Alternatively, coronary venous system ethanol ablation has been successfully employed by sub-selecting the vein of Marshall to facilitate mitral isthmus line block, although this approach is naturally limited to this area by the coronary venous anatomy. Increased awareness of the pathophysiological relevance of these epicardial structures and their intracardiac conduction patterns in the era of high-resolution 3D electro-anatomical mapping technology has allowed greater understanding of their contribution to the persistence of AF as well as failure to achieve transmural block by traditional ablation approaches. This might translate into novel catheter ablation strategies with procedural success rates comparable to surgical ‘cut-and-sew’ techniques. This review aims to give an overview of percutaneous catheter ablation strategies to target the SPB, an important cause of failed block across the roof line and isolation of the left atrial posterior wall and/or the pulmonary veins. Existing and investigational technologies will be discussed and an outlook of future approaches provided.

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