Participant-reported chest pain and gastric esophageal reflux disease following protective esophageal cooling during radiofrequency ablation for atrial fibrillation - the EVERCOOL-AF study.

BACKGROUND

Gastroesophageal 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.

METHODS

Participants 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.

RESULTS

There 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).

CONCLUSION

In 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.