Active esophageal cooling reduces peri-esophageal and vagal nerve injury in radiofrequency-current pulmonary vein isolation.

Background: Damage to peri-esophageal tissue may occur following pulmonary vein isolation (PVI). Active esophageal cooling has been shown to reduce the incidence of mucosal esophageal injury, probably by dissipation of heat and inhibition of inflammation. Whether it also protects the peri-esophageal vagal nerve plexus and reduces gastric hypomotility and food retention is uncertain. Objective: The study aimed to analyze and compare the incidence of esophageal and vagal nerve injury following radiofrequency-current (RF) PVI with active esophageal cooling to that of luminal esophageal temperature (LET) monitoring. Methods: Using endoscopy and electrogastrography, esophageal and peri-esophageal injury (mucosal lesions, food retention, and vagal nerve injury) were prospectively assessed following RF-PVI with active esophageal cooling and compared with RF-PVI with LET monitoring. Results: A total of 64 patients (69 [65/75] years, 58% men) undergoing RF-PVI for atrial fibrillation with esophageal cooling under (deep) conscious sedation were prospectively studied and compared with 52 LET-monitored patients.Following RF-PVI with active cooling, 4.7% had mucosal erythema, 15.6% new-onset food retention, and 14.1% ablation-induced vagal nerve injury. In comparison, the LET-monitored cohort showed 11.5% with mucosal esophageal lesions, 26.9% new-onset food retention, and 28.8% ablation-induced vagal nerve injury. The rate of any esophageal injury per patient was decreased by a factor of 0.51 ([95% confidence interval 0.30, 0.86]; Conclusion: In RF-PVI, active esophageal cooling reduces ablation-induced vagal nerve injury and overall peri-esophageal injury.