Esophageal cooling for protection: an innovative tool that improves the safety of atrial fibrillation ablation

ABSTRACT

This letter to the editor concerns the article: ‘Innovative tools for atrial fibrillation ablation’ by Rottner et al., published in the journal on 13th of May 2020. We read the article with great interest and congratulate the authors on an impressively detailed summary of the current tools and technological advances in atrial fibrillation ablation. Improving the safety of this procedure is very important due to widespread clinical practice and the increasing demand for this procedure. We would like to share further discussion with the authors and the journal’s readership on current advances in improving the safety of this procedure – esophageal cooling. The results of a large randomized trial was recently presented, the IMPACT study (NCT 03819946), which showed that a simple, standardized method of esophageal cooling with the ensoETM® device can significantly reduce esophageal thermal injury by 83.4%. Esophageal protection is important as esophageal injury has a high mortality rate to those that sustain this injury although the overall incidence is low. Rottner et al. discuss a much smaller study on esophageal cooling and the limitations of this study are also discussed.

KEYWORDS:

• Atrial fibrillation ablation
• catheter ablation
• safety
• esophageal injury
• atrio-esophageal fistula
• complications
• esophageal cooling
• esophageal protection

Declaration of interest

Dr Leung has received research support from Attune Medical

Dr Gallagher has received research funding from Attune Medical and has acted as a consultant and a paid speaker for Boston Scientific and Cook Medical.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.