ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2026
Participant-reported chest pain and gastric esophageal reflux disease following protective esophageal cooling during radiofrequency ablation for atrial fibrillation - the EVERCOOL-AF study.
Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundGastroesophageal reflux disease (GERD) and chest pain are common complications following catheter ablation for atrial fibrillation (AF), often attributed to esophageal thermal injury. Active esophageal cooling reduces thermal injury risk but may not reduce GERD symptoms. Factors associated with these complications, despite esophageal cooling, remain unclear. Our objective was to identify participant and procedural characteristics associated with post-ablation GERD and (CP) in AF participants undergoing radiofrequency ablation (RFA) with esophageal cooling.
methodsParticipants undergoing RFA with esophageal cooling for paroxysmal or persistent AF completed a standardized questionnaire. GERD symptoms were assessed with GERDQ (score ≥ 8 high probability of GERD) at 7-14 days post-procedure. Chest pain was queried separately. Associations with demographic and procedural variables were evaluated.
resultsThere were 295 out of a maximum of 312 participants completing post-ablation questionnaires that underwent esophageal cooling, 44 (14.9%) met criteria for GERD ≥ 8 and 71 (24.1%) reported CP. The anterior maximum power was significantly lower in participants with GERD compared to those without (50.0 vs. 54.0 ± 14.0 W, p = 0.020). Participants reporting CP were younger (64.5 ± 9.3 vs. 67.5 ± 10.2 years, p = 0.026) and had higher mean ejection fraction (57.1 ± 6.6% vs. 53.1 ± 10.2%, p = 0.001). Chest pain was less common if bilateral first-pass isolation was achieved (59.2% vs. 72.6%, p = 0.033).
conclusionIn participants undergoing AF ablation with active esophageal cooling, younger age, higher ejection fraction and lack of bilateral first-pass isolation were associated with post-ablation CP. These findings suggest that despite esophageal protection, both procedural and participant-specific factors may contribute to symptom development.
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