Abstract
Introduction: Proactive esophageal cooling has been FDA cleared
to reduce the likelihood of ablation-related esophageal injury resulting
from radiofrequency (RF) cardiac ablation procedures. Data suggest that
procedure times for RF pulmonary vein isolation (PVI) also decrease when
proactive esophageal cooling is employed instead of luminal esophageal
temperature (LET) monitoring. Reduced procedure times may allow
increased electrophysiology (EP) lab throughput. We aimed to quantify
the change in EP lab throughput of PVI cases after the introduction of
proactive esophageal cooling. Methods: EP lab throughput data
were obtained from three electrophysiology groups. We then compared EP
lab throughput over equal time frames at each site before (pre-adoption)
and after (post-adoption) the adoption of proactive esophageal cooling.
Results: Over the time frame of the study, a total of 2,498
PVIs were performed over a combined 74 months, with cooling adopted in
September 2021, November 2021 and March 2022 at each respective site. In
the pre-adoption time frame, 1,026 PVIs were performed using a
combination of LET monitoring with the addition of esophageal deviation
when deemed necessary by the operator. In the post-adoption time frame,
1,472 PVIs were performed using exclusively proactive esophageal
cooling, representing a mean 43% increase in throughput (p <
0.0001), despite the loss of two operators during the post-adoption time
frame. Conclusion: Adoption of proactive esophageal cooling
during PVI ablation procedures is associated with a significant increase
in EP lab throughput, even after a reduction in total number of
operating physicians in the post-adoption group.