1 Introduction
Atrial fibrillation (AF) is the most commonly diagnosed form of cardiac arrhythmia today 1 and its prevalence is expected to increase to 12.1 million cases by the year 2030.2While radiofrequency (RF) ablation is an effective treatment for AF, it can cause unintentional injury to surrounding tissue as a result of undesired conductive heating.3 One symptom of injury is chest pain resulting from acute pericarditis, vagal plexus thermal injury, gastroparesis, or local inflammation.4,5Post-ablation chest pain often results in the need for further treatment, and on average, incurs longer hospital stays and higher hospital charges for patients.6
A number of studies have investigated methods to reduce this complication. For example, colchicine has been evaluated for its potential role as a prophylactic medication.75 While a non-randomized study found colchicine to be effective, 8 a randomized study found it ineffective and reported significant gastrointestinal side effects.9 As such, effective prophylactic treatment regimens remain unclear, while instances of post-ablation chest pain remain high, with reports ranging from 10% to more than 50% of patients experiencing post-ablative chest pain.5,7,10,11
The use of active esophageal cooling has been cleared by the Food and Drug Administration (FDA) to reduce the likelihood of ablation-related esophageal injury resulting from RF cardiac ablation procedures.12-16 In general, cooling is known to have pleiotropic effects, primarily through mitigation of the activity of inflammatory mediators.17,18 These decreased local inflammatory effects may decrease chest pain from multiple etiologies. To examine this hypothesis further, we aimed to quantify the effect of active esophageal cooling on the rate of post-ablation chest pain by examining the incidence of patient-reported symptoms before and after adoption of active esophageal cooling.