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.