SynthesisJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2020
Esophageal cooling for protection during left atrial ablation: a systematic review and meta-analysis.
Synthesis in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04577859 (Improving Esophageal Protection During AF Ablation), which is not on this map. Cited by 23 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Improving Esophageal Protection During AF Ablation: a Multicenter Double-blind Randomized Clinical Trial
Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 51 citations in OpenAlex.
- Role of oesophageal cooling in the prevention of oesophageal injury in atrial fibrillation catheter ablation: a systematic review and meta-analysis of randomized controlled trials.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Pooled it
- Effect of esophageal cooling on ablation lesion formation in the left atrium: Insights from Ablation Index data in the IMPACT trial and clinical outcomes.Journal of cardiovascular electrophysiology · 2022Trial
- Active esophageal cooling for the prevention of thermal injury during atrial fibrillation ablation: a randomized controlled pilot study.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2022Trial
- Randomized comparison of oesophageal protection with a temperature control device: results of the IMPACT study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2021Trial
- Motion-based dynamic light delivery to minimize laser-related thermal damage while preserving photoacoustic image quality.Journal of biomedical optics · 2025Article
- Impact of the dispersive patch placement on dissipated power in radiofrequency ablation for pulmonary vein isolation via a virtual patient study.Scientific reports · 2025Article
- Mechanisms of action behind the protective effects of proactive esophageal cooling during radiofrequency catheter ablation in the left atrium.Heart rhythm O2 · 2024Review
- Safety of an esophageal deviator for atrial fibrillation catheter ablation.Heart rhythm O2 · 2023Article
- Letter to the editor: oesophageal cooling for protection during left atrial ablations.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Article
- An Esophageal Cooling Device During Radiofrequency Ablation for Atrial Fibrillation-A Comparison Between Reactive and Proactive Esophageal Cooling.The Journal of innovations in cardiac rhythm management · 2022Article
- Effects of water cooling on laser-induced thermal damage in rat hepatectomy.Lasers in surgery and medicine · 2022Article
- Protecting Against Collateral Damage to Non-cardiac Structures During Endocardial Ablation for Persistent Atrial Fibrillation.Arrhythmia & electrophysiology review · 2022Review
- Proactive esophageal cooling protects against thermal insults during high-power short-duration radiofrequency cardiac ablation.International journal of hyperthermia : the official journal of European Society for Hyperthermic Oncology, North American Hyperthermia Group · 2022Article
- Surgery and Catheter Ablation for Atrial Fibrillation: History, Current Practice, and Future Directions.Journal of clinical medicine · 2021Review
- Preventing esophageal complications from atrial fibrillation ablation: A review.Heart rhythm O2 · 2021Article
- Esophageal temperature during atrial fibrillation ablation poorly predicts esophageal injury: An observational study.Heart rhythm O2 · 2021Article
- Impact of Active Esophageal Cooling on Fluoroscopy Usage During Left Atrial Ablation.The Journal of innovations in cardiac rhythm management · 2021Article
- Successful fluoroless deviation of the esophagus during atrial fibrillation ablation.HeartRhythm case reports · 2021Article
- Why just detect? We can protect: A letter to the authors of "Prevention of left atrium esophagus fistula".Pacing and clinical electrophysiology : PACE · 2021Article
- Modeling esophageal protection from radiofrequency ablation via a cooling device: an analysis of the effects of ablation power and heart wall dimensions.Biomedical engineering online · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThermal damage to the esophagus is a risk from radiofrequency (RF) ablation of the left atrium for the treatment of atrial fibrillation (AF). The most extreme type of thermal injury results in atrio-esophageal fistula (AEF) and a correspondingly high mortality rate. Various strategies for reducing esophageal injury have been developed, including power reduction, esophageal deviation, and esophageal cooling. One method of esophageal cooling involves the direct instillation of cold water or saline into the esophagus during RF ablation. Although this method provides limited heat-extraction capacity, studies of it have suggested potential benefit. We sought to perform a meta-analysis of published studies evaluating the use of esophageal cooling via direct liquid instillation for the reduction of thermal injury during RF ablation.
methodsWe searched PubMed for studies that used esophageal cooling to protect the esophagus from thermal injury during RF ablation. We then performed a meta-analysis using a random effects model to calculate estimated effect size with 95% confidence intervals, with an outcome of esophageal lesions stratified by severity, as determined by post-procedure endoscopy.
resultsA total of 9 studies were identified and reviewed. After excluding preclinical and mathematical model studies, 3 were included in the meta-analysis, totaling 494 patients. Esophageal cooling showed a tendency to shift lesion severity downward, such that total lesions did not show a statistically significant change (OR 0.6, 95% CI 0.15 to 2.38). For high-grade lesions, a significant OR of 0.39 (95% CI 0.17 to 0.89) in favor of esophageal cooling was found, suggesting that esophageal cooling, even with a low-capacity thermal extraction technique, reduces the severity of lesions resulting from RF ablation.
conclusionsEsophageal cooling reduces the severity of the lesions that may result from RF ablation, even when relatively low heat extraction methods are used, such as the direct instillation of small volumes of cold liquid. Further investigation of this approach is warranted, particularly with higher heat extraction capacity techniques.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.