Co-Author(s):
Daniel Alexander, DO - Winchester Medical Center
Rebekah Smith, RN - Winchester Medical Center
Erik Kulstad, MD, MS - UT Southwestern Medical Center
Winchester Medical Center
Winchester Medical Center, 1840 Amherst Street, Winchester, VA 22601
Introduction | Objectives: Electrical isolation of the pulmonary veins utilizing the Cryoablation
balloon (Arctic Front, Medtronic) has been established as an effective
treatment for both paroxysmal and persistent atrial fibrillation (AF).
Esophageal injury as a result of convective thermal transfer is a rare,
but potentially fatal complication of both radiofrequency and
cryoablation techniques. Active warming of the esophagus during
cryotherapy offers a proactive approach to countering potential
cryothermal injury which does not require repositioning during use.
This prospective study (NCT04087122) measured the difference in
procedure time between patients treated with and without an esophageal
warming device while undergoing cryoablation for the treatment of AF.
Methods: Patients scheduled for cryoablation were consented for enrollment, with
cryoablation performed in standard fashion with the exception of the
placement of an active esophageal warming device in place of the
standard temperature sensor. Warming device temperature was set to
42°C. Procedure times, left atrial time, and fluoroscopy usage for each
case were then compared to the previous consecutive cryoablation control
patients.
Results: A total of 20 patients were prospectively enrolled and received active
esophageal warming in place of standard LET monitoring. Mean total
procedure time was 126 minutes (95% CI 112 to 139 minutes) and median
time was 119.5 minutes (IQR 29 minutes). A total of 25 patients served
as historical controls, with mean total procedure time of 141 minutes
(95% CI 126 to 156 minutes), and median time of 132 minutes (IQR 28
minutes), p=0.03, Mann-Whitney U Test. Time from transeptal access to
last pacing maneuver to confirm exit block (used as a surrogate for left
atrial time); and the total fluoroscopy time were shorter in the active
esophageal warming group by 5% and 6% respectively. These trended
towards, but did not reach, statistical significance. In one and three
month follow up, no complications, including stroke or esophageal injury
were identified.
Conclusions: Use of active esophageal warming avoids the need for procedural
interruptions and temperature probe repositioning, which appears to
improve efficiency by reducing total procedure time.