Impact of active esophageal cooling on catheter ablation procedure times across five healthcare systems

Abstract Background Increased efficiency in procedure times may improve electrophysiology lab throughput and enhance patient care. The choice of esophageal protection method during pulmonary vein isolation (PVI) can affect procedural efficiency, with recent data suggesting that active esophageal cooling is associated with shorter procedure times when compared with luminal esophageal temperature (LET) monitoring. Objective To compare PVI procedure times before and after the adoption of active esophageal cooling in a large multicenter analysis. Methods Procedural data were obtained from 5 hospital systems before and after they adopted active esophageal cooling. Patient age, gender, and total procedure time were recorded and compared between groups before and after adoption of esophageal cooling. Results A total of 2,280 patient procedures completed by 16 different physiologists were reviewed from a total of 6 hospitals. The hospitals included academic medical centers, community hospitals, and integrated healthcare delivery systems. Prior to adopting active esophageal cooling, patients were treated with LET monitoring using either single or multi-sensor temperature probes. For the actively cooled patients the mean age was 66.7 ± 10.9 years and 33.5% were female. For the LET monitored patients the mean age was 64.2 ± 10.7 years and 34.5% were female. A total of 928 patients were treated with LET monitoring, with a mean procedure time of 173 ± 73 minutes. A total of 1352 patients were treated with active esophageal cooling, with a mean procedure time of 113 ± 51 minutes, representing a decrease of 60 minutes, or 34.7% of procedure time, compared with active esophageal cooling (P<.001). Conclusions Active esophageal cooling during PVI was associated with up to a 34.7% reduction in procedure duration when compared to LET monitoring in this large multicenter analysis.