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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.

Hamed, Mohamed; Elseidy, Sheref A; Abdelazeem, Mohamed; Morcos, Ramez; Abdallah, Ahmed; Sammour, Yasser; Barakat, Amr F; Khalife, Wissam; Ramu, Vijay; Mamas, Mamas A; Elbadawi, Ayman

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. Thumbnail


Authors

Mohamed Hamed

Sheref A Elseidy

Mohamed Abdelazeem

Ramez Morcos

Ahmed Abdallah

Yasser Sammour

Amr F Barakat

Wissam Khalife

Vijay Ramu

Ayman Elbadawi



Abstract

AIMS: To evaluate the efficacy of oesophageal cooling in the prevention of oesophageal injury in patients undergoing atrial fibrillation (AF) catheter ablation. METHODS AND RESULTS: Comprehensive search of MEDLINE, EMBASE, and Cochrane databases through April 2022 for randomized controlled trials (RCTs) evaluating the role of oesophageal cooling compared with control in the prevention of oesophageal injury during AF catheter ablation. The study primary outcome was the incidence of any oesophageal injury. The meta-analysis included 4 RCTs with a total of 294 patients. There was no difference in the incidence of any oesophageal injury between oesophageal cooling and control [15% vs. 19%; relative risk (RR) 0.86; 95% confidence interval (CI) 0.31-2.41]. Compared with control, oesophageal cooling showed lower risk of severe oesophageal injury (1.5% vs. 9%; RR 0.21; 95% CI 0.05-0.80). There were no significant differences among the two groups in mild to moderate oesophageal injury (13.6% vs. 12.1%; RR 1.09; 95% CI 0.28-4.23), procedure duration [standardized mean difference (SMD) -0.03; 95% CI -0.36-0.30], posterior wall radiofrequency (RF) time (SMD 0.27; 95% CI -0.04-0.58), total RF time (SMD -0.50; 95% CI -1.15-0.16), acute reconnection incidence (RR 0.93; 95% CI 0.02-36.34), and ablation index (SMD 0.16; 95% CI -0.33-0.66). CONCLUSION: Among patients undergoing AF catheter ablation, oesophageal cooling did not reduce the overall risk of any oesophageal injury compared with control. Oesophageal cooling might shift the severity of oesophageal injuries to less severe injuries. Further studies should evaluate the long-term effects after oesophageal cooling during AF catheter ablation.

Citation

Hamed, M., Elseidy, S. A., Abdelazeem, M., Morcos, R., Abdallah, A., Sammour, Y., …Elbadawi, A. (2023). 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. EP-Europace, https://doi.org/10.1093/europace/euad080

Acceptance Date Feb 28, 2023
Publication Date Apr 6, 2023
Journal EP-Europace
Print ISSN 1099-5129
Electronic ISSN 1532-2092
Publisher Oxford University Press
DOI https://doi.org/10.1093/europace/euad080
Keywords Atrial fibrillation; Catheter ablation; Radiofrequency ablation; Oesophageal cooling; Oesophageal injury
Publisher URL https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euad080/7109777