Association Between Proactive Esophageal Cooling and Increased Lab Throughput

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.