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Reduced Post-Ablation Chest Pain with Active Esophageal Cooling
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  • William Zagrodzky,
  • Allison Small,
  • Christopher Joseph,
  • Julie Cooper,
  • Erik Kulstad,
  • Babette Brumback,
  • Kamran Aslam
William Zagrodzky
Colorado College

Corresponding Author:[email protected]

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Allison Small
Fordham University
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Christopher Joseph
The University of Texas Southwestern Medical Center
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Julie Cooper
The University of Texas Southwestern Medical Center
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Erik Kulstad
The University of Texas Southwestern Medical Center
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Babette Brumback
University of Florida Department of Biostatistics
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Kamran Aslam
Texas Cardiac Arrhythmia
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Introduction: Post-ablation chest pain is a common occurrence in patients after radiofrequency (RF) pulmonary vein isolation (PVI) ablation for the treatment of atrial fibrillation (AF), with a reported incidence of up to 50%. Pain can be caused by pericarditis, vagal plexus thermal injury, gastroparesis, or local inflammation. Active esophageal cooling is FDA cleared for reducing the likelihood of ablation-related esophageal injury resulting from RF cardiac ablation procedures, but cooling has also been reported to have pleiotropic effects which may mitigate inflammation and reduce the likelihood of post-ablation chest pain. The aim of this study is to quantify the change in incidence of post-ablation chest pain after the adoption of active esophageal cooling during RF ablations. Methods: Data from a community hospital registry were obtained for the 12 months prior to (pre-adoption), and the 12 months after adoption (post-adoption) of active esophageal cooling in December 2021 during RF ablations. Type of ablation was recorded, along with patient’s age, post-ablation symptoms, and type of prophylactic treatment utilized. Incidence rates of chest pain before and after adoption of esophageal cooling were then compared. Results: Data were reviewed from 183 patients. In the pre-adoption cohort, patients were given 2 weeks of daily sucralfate and pantoprazole, with an additional 4 weeks in cases with persisting symptoms. In this group, 90 patients (66.7% persistent AF) with a mean age of 69.6 years (SD ± 10.34) received PVI, with 62 (68.9%) receiving roof lines, 60 (66.7%) receiving floor lines, and 41 (45.6%) reporting post-ablation chest pain requiring extension of treatment to 6 weeks. In the post-adoption cohort, 2 days of sucralfate and pantoprazole was given, and a total of 93 patients (75.2% persistent AF) with a mean age of 68.3 years (SD ± 10.28) received PVI, with 79 (84.5%) receiving roof lines, 75 (80.6%) receiving floor lines, and none reporting post-ablation chest pain (p<0.0001). Conclusion: Adoption of active esophageal cooling was associated with a significant reduction in post-ablation chest pain despite increased use of posterior wall isolation and decreased use of prophylactic treatment.
10 Nov 2023Submitted to Journal of Cardiovascular Electrophysiology
10 Nov 2023Review(s) Completed, Editorial Evaluation Pending
10 Nov 2023Assigned to Editor
10 Nov 2023Submission Checks Completed
12 Nov 2023Reviewer(s) Assigned