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The Lead Episode 26: A Discussion of Atrioesophageal Fistula Rates Before and After Adoption of Active Esophageal Cooling During Atrial Fibrillation Ablation
This institutional review board (IRB)-approved study was a prospective analysis of retrospective data, designed before collecting and analyzing the real-world data. The number of AEFs occurring in equivalent time frames before and after adoption of cooling using a dedicated esophageal cooling device (ensoETM, Attune Medical) were quantified across 25 prespecified hospital systems. AEF rates were then compared using generalized estimating equations robust to cluster correlation. A total of 14,224 patients received active esophageal cooling during RF ablation across the 25 hospital systems, which included a total of 30 separate hospitals.
Learning Objectives
  • Frequency of atrio-esophageal fistula (AEF) with RF ablation of AF.
  • Impact on clinical AEF with use of a closed loop cooling system.
Article Authors and Podcast Contributors
Article Authors
Javier Sanchez, MD, Christopher Woods, MD, PHD, Jason Zagrodzky, MD,a Jose Nazari, MD, Matthew J. Singleton, MD, MSC, MBE, Amir Schricker, MD, Annie Ruppert, RN, Babette Brumback, PHD, Benjamin Jenny, MD, MBA, Charles Athill, MD, Christopher Joseph, MD, Dipak Shah, MD, Gaurav Upadhyay, MD, Erik Kulstad, MD, MS, John Cogan, MD, Jordan Leyton-Mange, MD, Julie Cooper, MD, Kamala Tamirisa, MD, Samuel Omotoye, MD, Saroj Timilsina, MD, Alejandro Perez-Verdia, MD, Andrew Kaplan, MD, Apoor Patel, MD, Alex Ro, MD, Andrew Corsello, MD, Arun Kolli, MD, Brian Greet, MD, Danya Willms, BA, David Burkland, MD, Demetrio Castillo, MD, Firas Zahwe, MD, Hemal Nayak, MD, James Daniels, MD, John MacGregor, MD, Matthew Sackett, MD, W. Michael Kutayli, MD, Michel Barakat, MD, Robert Percell, MD, Spyridon Akrivakis, MD, Steven C. Hao, MD, Taylor Liu, MD, PHD, Ambrose Panico, DO, Archana Ramireddy, MD, Thomas Dewland, MD, Edward P. Gerstenfeld, MD, Daniel Benhayon Lanes, MD, Edward Sze, MD, Gregory Francisco, MD, Jose Silva, MD, Julia McHugh, MD, PHD, Kai Sung, MD, Leon Feldman, MD, Nicholas Serafini, MD, Raymond Kawasaki, MD, Richard Hongo, MD, Richard Kuk, MD, Robert Hayward, MD, Shirley Park, MD, Andrew Vu, MD, Christopher Henry, MD, Shane Bailey, MD, Steven Mickelsen, MD, Taresh Taneja, MD, Westby Fisher, MD, Mark Metzl, MD

Podcast Contributors
Prashanthan Sanders, MBBS, PhD, FHRS, of University of Adelaide

Han S. Lim, MBBS, PhD, FHRS, of Austin and Northern Health, University of Melbourne

Venkatakrishna N. Tholakanahalli, MD, FHRS, of Minneapolis VA Health Care System

Disclosure Policy

ACE Disclosure Policy

The Heart Rhythm Society is committed to the provision of Accredited Continuing Education (formerly known as Continuing Medical Education (CME)) that is balanced, objective, and evidence based. HRS adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME) which require that those individuals in a position to control the content of an educational activity (including, but not limited to, planners, faculty, authors, committee members, content reviewers, editors, and staff) disclose all financial relationships with an ACCME-defined ineligible company* within the 24 months prior to the disclosure.


Any individual who refuses to disclose financial relationships is disqualified from participating in HRS ACE-certified activities. Owners and employees of ACCME-defined ineligible companies may have no role in the planning or implementation of ACE activities without a special written exemption from the HRS Chief Learning Officer that will be granted only in specific circumstances that meet ACCME requirements.

ACCME Definition:

*An ineligible company is one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Examples of such organizations include:

  • Advertising, marketing, or communication firms whose clients are ineligible companies
  • Bio-medical startups that have begun a governmental regulatory approval process
  • Compounding pharmacies that manufacture proprietary compounds
  • Device manufacturers or distributors
  • Diagnostic labs that sell proprietary products
  • Growers, distributors, manufacturers or sellers of medical foods and dietary supplements
  • Manufacturers of health-related wearable products
  • Pharmaceutical companies or distributors
  • Pharmacy benefit managers
  • Reagent manufacturers or sellers


All relevant financial relationships have been mitigated.

Host Disclosure(s):
P. Sanders: Research (Contracted Grants for PIs Named Investigators Only): Boston Scientific, Abbott, Medtronic, PaceMate, Becton Dickinson, CathRx; Advisory Committee Membership: Medtronic, Boston Scientific, PaceMate, CathRx

Contributor Disclosure(s):
H. Lim: No relevant financial relationships with ineligible companies to disclose.
V. Tholakanahalli: Honoraria/Speaking/Consulting Fee: Kobra Medical, Imricor; Research (Contracted Grants for PIs Named Investigators Only): Biosense, St. Jude Medical, Cardailen

Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):
J. Glenn: No relevant financial relationships with ineligible companies to disclose. 
S. Sailor: No relevant financial relationships with ineligible companies to disclose.
Availability: On-Demand
Cost: FREE
Credit Offered:
No Credit Offered
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