Introduction
Atrial fibrillation (AF) is the most common form of arrhythmia diagnosed
in the United States today.1 With the incidence of AF
rising and the population continuing to age, 2 the
demand for pulmonary vein isolation (PVI) has steadily
increased.3-5 As a result, waiting lists for PVI
procedures have lengthened.6,7 Tools or techniques
that increase electrophysiology (EP) lab throughput may help alleviate
this constraint.
A dedicated device for proactive esophageal cooling has recently
received clearance from the US Food and Drug Administration (FDA) to
reduce the likelihood of ablation-related esophageal injury resulting
from radiofrequency (RF) cardiac ablation procedures.8With increasing adoption of this safety device, additional findings have
been reported with its use. 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 A multi-site study of 373
patients found that median procedure time was reduced from 141 [IQR
104 to 174] minutes with LET monitoring to 100 [IQR 84 to 122]
minutes with proactive cooling, representing a reduction of 41 minutes,
or 29.1% of total procedure time
(pā<ā.001).17 Similar trends in reductions
in procedure durations have been observed at a variety of different EP
groups across the country upon adoption of cooling. Shorter procedures
may help improve patient safety by minimizing the additional risk that
comes with prolonged time under anesthesia 18 and may
also allow more procedures to be completed.19
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.