Reply to “Additional Data Protection of the Esophagus
During Catheter Ablation of Atrial Fibrillation”
Mahmoud Houmsse, MD, and Emile G. Daoud, MD
Department of Medicine, Division of Cardiology, Richard M. Ross Heart
Hospital
The Ohio State University Medical Center, Columbus, OH
Running Title: Protection of Esophagus
Address for correspondence: Emile Daoud, MD
DHLRI
473 W. 12th Avenue, Suite 200
Columbus, OH 43210-1252
Telephone: 877-478-2478
FAX : 614-293-5614
E-Mail:
emile.daoud@osumc.edu
Funding: None
Disclosure: Emile Daoud and The Ohio State University have
equity ownership and serve as consultants to S4 Medical Corp, which is
manufacturing the Esoultion esophageal retractor.
Disclosure: Mahmoud Houmsse has no conflict of interest
We Thank Dr.Clark and Dr. Kulstad for their interest in our recent
review manuscript “protection of the esophagus during catheter ablation
of atrial fibrillation”
We agree with Dr. Clark and Dr. Kulstad that utilization of luminal
esophageal temperature (LET) monitoring during atrial fibrillation
ablation is inadequate method to avoid esophageal injury. These have
been reported in multiple studies that were referenced in our
manuscript. The newer published studies regrading monitoring LET during
atrial fibrillation ablation, which were reported by Dr. Clark and Dr.
Kulstad, have been published during our manuscript publication process.
Nevertheless, these studies that reported by Dr. Clark and Dr. Kulstad
showed same conclusion of inadequate LET monitoring in preventing
esophageal injury 1-3.
Regarding active cooling, Dr. Clark and Dr. Kulstad reported recent
published studies. First study small pilot study that showed active
cooling is much more protective than manual liquid
instillation4. The second pilot RCT that compared LET
and active cooling showed same outcome like the IMPACT study that we
reported in our manuscript 5,6.
We agree with Dr. Clark and Kulstad, growing interest in the area of
esophageal protection during atrial fibrillation ablation.
We do believe, as we stated in the conclusion of our manuscript, that
“a reliable method to protect the esophagus is of clinical value, but
the ancillary value of reducing physician concern during AF ablation,
reducing interruption to ablation work flow, perhaps enhancing AF
ablation results and simplifying post procedure management of patient
symptoms are also of high importance. Considering the ease of use,
minimal side effects, and low costs associated with esophageal
protection devices, these features offer compelling evidence for use of
esophageal protection as routine care for AF ablation”.