PO-02-074 A META-ANALYSIS TO EVALUATE THE EFFICACY OF ESOPHAGEAL COOLING IN PREVENTING ESOPHAGEAL INJURY DURING RADIOFREQUENCY ABLATION

Abstract

Esophageal injury during radiofrequency (RF) ablation of atrial fibrillation (AF) is a known complication. It could range from mild esophagitis to esophageal ulcers. Atrio-esophageal fistula (AEF) is the most dreaded complication. It is rare but potentially life-threatening. Various measures to reduce esophageal injury including esophageal temperature monitoring, reducing ablation power on the posterior wall and esophageal deviation have been used. Esophageal cooling during RF ablation has been used as a strategy to reduce esophageal injury. We performed a meta-analysis evaluating the efficacy of esophageal cooling during RF ablation in reducing esophageal injury. We performed a systematic literature review in Embase, PubMed and SCOPUS for all the related articles until December 2022. The literature search yielded 28 publications, of which 6 studies fulfilled inclusion criteria. The Mantel- Haenszel random effects model was used to calculate odds ratio (OR) and 95% confidence intervals (CI). Outcomes analyzed were all esophageal lesions, mild to moderate and severe esophageal lesions as determined by post-procedure endoscopy. Esophageal cooling was performed in 469 patient and no esophageal cooling was used in 195 patients. Esophageal cooling significantly reduced severe esophageal injuries (OR = 0.37, 95% CI [0.18-0.79], P=0.01). There was no significant difference between the treatment groups in total number of esophageal lesion (OR = 0.60, 95% CI [0.22-1.64], P=0.32) and mild to moderate lesions (OR = 1.48, 95% CI [0.48-4.51], P=0.49). Esophageal cooling during RF ablation in the left atrium reduces the incidence of severe esophageal lesions.