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Meta-Analysis
. 2023 May 19;25(5):euad080.
doi: 10.1093/europace/euad080.

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

Mohamed Hamed  1 , Sheref A Elseidy  2 , Mohamed Abdelazeem  3 , Ramez Morcos  4 , Ahmed Abdallah  5 , Yasser Sammour  6 , Amr F Barakat  7 , Wissam Khalife  8 , Vijay Ramu  5 , Mamas A Mamas  9 , Ayman Elbadawi  10
Affiliations
Meta-Analysis

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

Mohamed Hamed et al. Europace. .

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.

Keywords: Atrial fibrillation; Catheter ablation; Oesophageal cooling; Oesophageal injury; Radiofrequency ablation.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Study flowsheet.
Figure 2
Figure 2
Forrest plot for any oesophageal injury, severe oesophageal injury, mild–moderate oesophageal injury, and procedural duration.
Figure 3
Figure 3
Forrest plot for posterior wall RF time, total radiofrequency time, acute reconnection incidence, and ablation index.
See this image and copyright information in PMC

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