LAUSR

Ablation of the left atrium with radiofrequency (RF) energy is associated with some risks to the esophagus.  Cooling the esophagus has been used as one approach to reducing esophageal injury, most commonly with direct instillation of cold liquid via gastric tube placed in the esophagus.  A new esophageal cooling device avoids the risks of free liquid instillation by using a closed-loop system, and avoids the need for frequent repositioning or stopping of the procedure often required when utilizing luminal esophageal temperature (LET) monitoring.  This in turn may reduce fluoroscopy requirements for the procedure. Measure the difference in fluoroscopy time required during RF ablation using an esophageal cooling device protocol, and compare this to standard LET monitoring using single or multi-sensor temperature probes. We obtained total fluoroscopy time per patient from records of RF ablation procedures performed by a two operators over a 12 month period.  We compared fluoroscopy times between patients treated with an esophageal cooling device to control patients who were treated with LET monitoring using either single-sensor or multi-sensor temperature probes. Fluoroscopy times were available for a total of 179 patients treated with an esophageal cooling device, and 118 patients treated with LET monitoring over the 12 month study period.  Mean fluoroscopy time for patients treated with esophageal cooling was 4.0 minutes (SD 4.9 minutes) with a median of 2.0 minutes (IQR 1.3 to 3.8 minutes).  Mean fluoroscopy time for patients undergoing LET monitoring was 5.5 minutes (SD 5.7 minutes) with a median of 3.0 minutes (IQR 1.9 to 8.4 minutes).  This difference represents a 27% reduction in mean fluoroscopy time, and a 33% reduction in median fluoroscopy time in the esophageal cooling group (p<.001, Mann-Whitney U test).  Fluoroscopy requirements were reduced by 27% with an esophageal cooling device when compared to standard LET monitoring.