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Zagrodzky W, Cooper J, Joseph C, Sackett M, Silva J, Kuk R, McHugh J, Brumback B, Park S, Hayward R, Taneja T, Vu A, Liu T, Kulstad E, Kaplan A, Ramireddy A, Omotoye S. Association between proactive esophageal cooling and increased lab throughput. J Cardiovasc Electrophysiol 2024. [PMID: 38566579 DOI: 10.1111/jce.16263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/29/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
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 EP 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 2498 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, 1026 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, 1472 PVIs were performed using exclusively proactive esophageal cooling, representing a mean 43% increase in throughput (p < .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.
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Affiliation(s)
| | - Julie Cooper
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Matthew Sackett
- Centra Health, Centra Lynchburg General Hospital and Centra Specialty Hospital, Lynchburg, Virginia, USA
| | - Jose Silva
- Centra Health, Centra Lynchburg General Hospital and Centra Specialty Hospital, Lynchburg, Virginia, USA
| | - Richard Kuk
- Centra Health, Centra Lynchburg General Hospital and Centra Specialty Hospital, Lynchburg, Virginia, USA
| | - Julia McHugh
- Centra Health, Centra Lynchburg General Hospital and Centra Specialty Hospital, Lynchburg, Virginia, USA
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Shirley Park
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Robert Hayward
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Taresh Taneja
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Andrew Vu
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Taylor Liu
- Kaiser Permanente, Santa Clara Medical Center, Santa Clara, California, USA
| | - Erik Kulstad
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Sanchez J, Woods C, Zagrodzky J, Nazari J, Singleton MJ, Schricker A, Ruppert A, Brumback B, Jenny B, Athill C, Joseph C, Shah D, Upadhyay G, Kulstad E, Cogan J, Leyton-Mange J, Cooper J, Tamirisa K, Omotoye S, Timilsina S, Perez-Verdia A, Kaplan A, Patel A, Ro A, Corsello A, Kolli A, Greet B, Willms D, Burkland D, Castillo D, Zahwe F, Nayak H, Daniels J, MacGregor J, Sackett M, Kutayli WM, Barakat M, Percell R, Akrivakis S, Hao SC, Liu T, Panico A, Ramireddy A, Dewland T, Gerstenfeld EP, Lanes DB, Sze E, Francisco G, Silva J, McHugh J, Sung K, Feldman L, Serafini N, Kawasaki R, Hongo R, Kuk R, Hayward R, Park S, Vu A, Henry C, Bailey S, Mickelsen S, Taneja T, Fisher W, Metzl M. Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation. JACC Clin Electrophysiol 2023; 9:2558-2570. [PMID: 37737773 DOI: 10.1016/j.jacep.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Active esophageal cooling reduces the incidence of endoscopically identified severe esophageal lesions during radiofrequency (RF) catheter ablation of the left atrium for the treatment of atrial fibrillation. A formal analysis of the atrioesophageal fistula (AEF) rate with active esophageal cooling has not previously been performed. OBJECTIVES The authors aimed to compare AEF rates before and after the adoption of active esophageal cooling. METHODS This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. RESULTS A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals. In the time frames before adoption of active cooling, a total of 10,962 patients received primarily luminal esophageal temperature (LET) monitoring during their RF ablations. In the preadoption cohort, a total of 16 AEFs occurred, for an AEF rate of 0.146%, in line with other published estimates for procedures using LET monitoring. In the postadoption cohort, no AEFs were found in the prespecified sites, yielding an AEF rate of 0% (P < 0.0001). CONCLUSIONS Adoption of active esophageal cooling during RF ablation of the left atrium for the treatment of atrial fibrillation was associated with a significant reduction in AEF rate.
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Affiliation(s)
| | | | | | - Jose Nazari
- NorthShore University Health System, Evanston, Illinois, USA
| | | | - Amir Schricker
- Mills-Peninsula Medical Center, Burlingame, California, USA
| | | | | | | | | | | | - Dipak Shah
- Ascension Michigan, Detroit, Michigan, USA
| | | | - Erik Kulstad
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
| | - John Cogan
- Memorial Healthcare System, Hollywood, Florida, USA
| | | | - Julie Cooper
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | | | | | | | | | - Apoor Patel
- Houston Methodist Hospital, Houston, Texas, USA
| | - Alex Ro
- NorthShore University Health System, Evanston, Illinois, USA
| | | | | | - Brian Greet
- Texas Cardiac Arrhythmia Institute, Austin, Texas, USA
| | - Danya Willms
- Sharp Memorial Hospital, San Diego, California, USA
| | | | | | | | - Hemal Nayak
- University of Texas, San Antonio, Texas, USA
| | - James Daniels
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Matthew Sackett
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | | | | | | | | | - Steven C Hao
- Sutter Pacific Medical Foundation, San Francisco, California, USA
| | - Taylor Liu
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | | | | | - Thomas Dewland
- University of California-San Fransisco, San Fransico, California, USA
| | | | | | - Edward Sze
- MaineHealth Cardiology, Portland, Maine, USA
| | | | - Jose Silva
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | - Julia McHugh
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | - Kai Sung
- Tri-City Cardiology, Mesa, Arizona, USA
| | - Leon Feldman
- Eisenhower Medical Center, Rancho Mirage, California, USA
| | | | - Raymond Kawasaki
- Northwest Community Healthcare, Arlington Heights, Illinois, USA
| | - Richard Hongo
- California Pacific Medical Center, San Francisco, California, USA
| | - Richard Kuk
- Centra Heart and Vascular Institute, Lynchburg, Virginia, USA
| | - Robert Hayward
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | - Shirley Park
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | - Andrew Vu
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | | | - Shane Bailey
- LoneStar Heart and Vascular, New Braunfels, Texas, USA
| | | | - Taresh Taneja
- Kaiser Permanente Northern California, Santa Clara, California, USA
| | - Westby Fisher
- NorthShore University Health System, Evanston, Illinois, USA
| | - Mark Metzl
- NorthShore University Health System, Evanston, Illinois, USA
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