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<b>Introduction</b>: Post-ablation chest pain is a common occurrence
in patients after radiofrequency (RF) pulmonary vein isolation (PVI)
ablation for the treatment of atrial fibrillation (AF), with a reported
incidence of up to 50%. Pain can be caused by pericarditis, vagal
plexus thermal injury, gastroparesis, or local inflammation. Active
esophageal cooling is FDA cleared for reducing the likelihood of
ablation-related esophageal injury resulting from RF cardiac ablation
procedures, but cooling has also been reported to have pleiotropic
effects which may mitigate inflammation and reduce the likelihood of
post-ablation chest pain. The aim of this study is to quantify the
change in incidence of post-ablation chest pain after the adoption of
active esophageal cooling during RF ablations. <b>Methods</b>: Data
from a community hospital registry were obtained for the 12 months prior
to (pre-adoption), and the 12 months after adoption (post-adoption) of
active esophageal cooling in December 2021 during RF ablations. Type of
ablation was recorded, along with patient’s age, post-ablation symptoms,
and type of prophylactic treatment utilized. Incidence rates of chest
pain before and after adoption of esophageal cooling were then compared.
<b>Results</b>: Data were reviewed from 183 patients. In the
pre-adoption cohort, patients were given 2 weeks of daily sucralfate and
pantoprazole, with an additional 4 weeks in cases with persisting
symptoms. In this group, 90 patients (66.7% persistent AF) with a mean
age of 69.6 years (SD ± 10.34) received PVI, with 62 (68.9%) receiving
roof lines, 60 (66.7%) receiving floor lines, and 41 (45.6%) reporting
post-ablation chest pain requiring extension of treatment to 6 weeks. In
the post-adoption cohort, 2 days of sucralfate and pantoprazole was
given, and a total of 93 patients (75.2% persistent AF) with a mean age
of 68.3 years (SD ± 10.28) received PVI, with 79 (84.5%) receiving roof
lines, 75 (80.6%) receiving floor lines, and none reporting
post-ablation chest pain (p&lt;0.0001). <b>Conclusion</b>:
Adoption of active esophageal cooling was associated with a significant
reduction in post-ablation chest pain despite increased use of posterior
wall isolation and decreased use of prophylactic treatment.</div>