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 (p < .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.