Quantification of Daily Radiofrequency Ablation Volumes in a Lab Using Active Esophageal Cooling

Daniel Moehringer, Student – Student, Virginia Tech; Julie Cooper, MD – Physician, University of Texas Southwestern Medical Center; Christopher Joseph, MD – Physician, University of Texas Southwestern Medical Center; Natalie Putzel, Student – Student, University of Southern California; Jacob Sherman, Student – Student, Washington University in St. Louis; Catherine Lazarus, Student – Student, Northwestern University; Erik Kulstad, MD, MS – Physician, University of Texas Southwestern Medical Center; Shane Bailey, MD – Electrophysiologist, Texas Cardiac Arrhythmia; Jason Zagrodzky, MD – Electrophysiologist, Texas Cardiac Arrhythmia

Purpose: Proactive esophageal cooling has been FDA cleared to reduce the likelihood of esophageal injury during radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF). Additional effects from cooling include shorter procedure times, which may allow increased procedural throughput and in turn help alleviate growing patient waitlists for pulmonary vein isolations (PVI) procedures. We aimed to measure the number of PVIs performed per day in a high-volume electrophysiology lab to determine the potential daily procedure throughput with proactive esophageal cooling.

Material and Methods: We analyzed data from a single electrophysiology lab over a 4-month period beginning in October 2019. The total number of PVI cases performed on each day was recorded, along with patient age, gender, body mass index, CHA2DS2-VASc score, total RF time, type of AF, and whether the PVI was the first versus a redo-ablation.

Results: Of the 70 patients treated, the mean patient age was 66.7 (SD ± 10.6) years, 38% of patients were female, mean body mass index was 31.5 (SD ± 6.8), and mean CHA2DS2-VASc score was 2.7 (SD ± 1.6). Of these 70 patients, 40.1% had paroxysmal AF, 47.1% had persistent AF, and 12.7% had long-standing persistent AF. A total of 17.8% of patients had received a previous ablation. Total RF time averaged 35.6 (SD ± 14.7) minutes. On operating days, an average of 2.2 PVIs (SD ± 1.4) were performed, ranging from 1 to up to 7 cases completed by a single operator per day.

Conclusions: Despite a patient population with a high age and comorbidity burden, up to 7 ablation procedures a day can be performed by a single operator using proactive esophageal cooling.