Lazarus Catherine, Sherman Jacob, Putzel Natalie, Randolph Cameron, Zagrodzky William, Sharkoski Tiffany, Ro Alex, Nazari Jose, Fisher Westby, Kulstad Erik, Metzl Mark D
Northwestern University, Evanston, Illinois.
Washington University in St. Louis, St. Louis, Missouri.
Heart Rhythm O2. 2025 Feb 21;6(5):606-611. doi: 10.1016/j.hroo.2025.02.010. eCollection 2025 May.
Proactive esophageal cooling is Food and Drug Administration (FDA) cleared to reduce the likelihood of esophageal injury during radiofrequency ablation for treatment of atrial fibrillation (AF). Long-term follow-up data have also shown improved freedom from arrhythmia with proactive esophageal cooling compared with luminal esophageal temperature (LET) monitoring during pulmonary vein isolation (PVI). One hypothesized mechanism is improved lesion contiguity (as measured by the continuity index) with the use of cooling.
We aimed to compare the continuity index of PVI cases using proactive esophageal cooling with those using LET monitoring.
We calculated the continuity index for PVI cases at 2 different hospitals within the same health system, using a slightly modified continuity index to facilitate retrospective determination from review of recorded cases. The results were then compared between cases using proactive esophageal cooling and those using LET monitoring.
Continuity Indices for a total of 236 cases were determined: 118 cases using proactive esophageal cooling and 118 cases using traditional LET monitoring. With proactive esophageal cooling, the average continuity index was 10.6 (5.6 on the left pulmonary vein and 4.9 on the right pulmonary vein). With LET monitoring, the average continuity index was 37.0 (18.7 on the left and 18.3 on the right), for a difference of 26.4 ( < .001).
Proactive esophageal cooling during PVI is associated with significantly improved lesion contiguity when compared with LET monitoring. This finding may offer a mechanism for the greater freedom from arrhythmia seen with proactive cooling in long-term follow-up.
主动式食管冷却已获得美国食品药品监督管理局（FDA）批准，可降低房颤（AF）射频消融治疗期间食管损伤的可能性。长期随访数据还显示，与肺静脉隔离（PVI）期间的管腔内食管温度（LET）监测相比，主动式食管冷却可提高无心律失常的自由度。一种假设机制是使用冷却可改善病变连续性（通过连续性指数衡量）。
我们旨在比较使用主动式食管冷却的PVI病例与使用LET监测的病例的连续性指数。
我们计算了同一医疗系统内两家不同医院PVI病例的连续性指数，使用了略有修改的连续性指数以便于通过回顾记录病例进行回顾性确定。然后比较使用主动式食管冷却的病例与使用LET监测的病例的结果。
共确定了236例病例的连续性指数：118例使用主动式食管冷却，118例使用传统LET监测。使用主动式食管冷却时，平均连续性指数为10.6（左肺静脉为5.6，右肺静脉为4.9）。使用LET监测时，平均连续性指数为37.0（左为18.7，右为18.3），相差26.4（P<0.001）。
与LET监测相比，PVI期间的主动式食管冷却与病变连续性显著改善相关。这一发现可能为长期随访中主动冷却所见的更高无心律失常自由度提供一种机制。
