Abstract
Introduction: Trials evaluating the role of esophageal cooling in the prevention of esophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation have yielded mixed results. The aim of our study is to evaluate the efficacy of esophageal cooling in the prevention of esophageal injury in patients undergoing AF catheter ablation. Methods: Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of esophageal cooling compared with control in the prevention of esophageal injury during AF catheter ablation. The study's primary outcome was the incidence of total esophageal injury. Secondary outcomes included the incidence of severe esophageal injury, the incidence of mild to moderate esophageal injury, procedural duration, posterior wall duration, total radiofrequency (RF) time, acute reconnection incidence, and ablation index. Results: The meta-analysis included 4 RCTs with total of 294 patients. There was no significant difference in the incidence of total esophageal injury between esophageal cooling and control (15% vs. 19%; Relative Risk [RR] 0.86; 95% confidence interval [CI] 0.31 - 2.41; I 2 = 63%). However, compared with control, esophageal cooling showed lower risk of severe esophageal injury (0.01% vs. 0.09%; RR 0.21; 95% CI 0.05 - 0.80). There were no significant differences among the two groups in mild to moderate esophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28 - 4.23), procedure duration (standardized mean difference [SMD] -0.03; 95% CI -0.36 - 0.30), posterior wall duration (SMD 0.27; 95% CI -0.04 - 0.58), total RF time (SMD -0.50; 95% CI -1.15 - 0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02 - 36.34), and ablation index (SMD 0.16; 95% CI -0.33 - 0.66). Conclusions: Among patients undergoing AF catheter ablation, esophageal cooling did not show a significant difference in the incidence of total esophageal injury. However, it has shown a significant decrease in the risk of severe esophageal injury without affecting the ablation process. This can help decrease the progression to atrial-esophageal fistula. Further large RCTs are needed to better evaluate the role of esophageal cooling in the prevention of esophageal injury.
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