Author + information
- Received June 3, 2018
- Revision received July 23, 2018
- Accepted July 26, 2018
- Published online December 17, 2018.
- Alex Baher, MDa,b,∗,
- Mobin Kheirkhahan, MDb,∗,
- Stephen J. Rechenmacher, MDa,
- Qussay Marashly, MBBSb,
- Eugene G. Kholmovski, PhDb,c,d,
- Johannes Siebermair, MD MHBAb,e,f,
- Madan Acharya, MDa,
- Mossab Aljuaid, MDa,
- Alan K. Morris, MSb,
- Gagandeep Kaur, BSb,
- Frederick T. Han, MDa,b,
- Brent D. Wilson, MD PhDa,b,
- Benjamin A. Steinberg, MD, MHSa,b,
- Nassir F. Marrouche, MDa,b and
- Mihail G. Chelu, MD, PhDa,b,∗ ()
- aDivision of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
- bComprehensive Arrhythmia Research & Management Center, University of Utah, Salt Lake City, Utah
- cUtah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah
- dDepartment of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
- eDepartment of Medicine I, Grosshadern Clinic, University of Munich, Munich, Germany
- fGerman Cardiovascular Research Center partner site, Munich Heart Alliance, Munich, Germany
- ↵∗Address for correspondence:
Dr. Mihail G. Chelu, Division of Cardiology, University of Utah School of Medicine, 50 North Medical Drive, Salt Lake City, Utah 84123.
Objectives This study retrospectively evaluated the feasibility and esophageal thermal injury (ETI) patterns of high-power short-duration (HPSD) radiofrequency atrial fibrillation (AF) ablation.
Background ETI following AF ablation can lead to serious complications. Little consensus exists on the optimal radiofrequency power setting or on the optimal strategy to assess ETI.
Methods A total of 687 patients undergoing first-time AF ablation with either HPSD ablation (50 W for 5 s, n = 574) or low-power long-duration ablation (LPLD, ≤35 W for 10 to 30 s, n = 113) were analyzed. ETI was assessed by late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) within 24 h post-ablation. Patients with moderate or severe esophageal LGE had a follow-up MRI within 24 h to 1 week, and esophagogastroduodenoscopies were performed when significant gastrointestinal symptoms or persistent LGE on repeat MRI was present. AF recurrence adjusted for potential confounders was analyzed.
Results The average age was 69.0 ± 11.8 years in the group undergoing HPSD ablation versus 68.3 ± 11.6 years in the LPLD group (p = 0.554), with 67.1% versus 59.3% male (p = 0.111). Esophageal LGE patterns were similar (64.8% vs. 57.5% none, 21.0% vs. 28.3% mild, 11.5% vs. 11.5% moderate, 2.8% vs. 2.7% severe for HPSD vs. LPLD, respectively; p = 0.370) with no atrioesophageal fistulas. Mean procedure length was significantly shorter in the HPSD group (149 ± 65 min vs. 251 ± 101 min; p < 0.001). AF recurrence rates were similar in the 2 groups for the mean 2.5-year follow-up period (adjusted, 42% vs. 41%; p = 0.571).
Conclusions HPSD ablation results in similar ETI patterns, as assessed by same-day LGE MRI, compared with the LPLD setting but with significantly shorter procedure times. Recurrence rates at 2.5-year follow-up are similar.
- atrial fibrillation
- esophageal injury
- magnetic resonance imaging
- power setting
- radiofrequency ablation
- thermal injury
↵∗ Drs. Baher and Kheirkhahan contributed equally to this paper and are joint first authors.
Dr. Kholmovski has equity interest in Marrek, Inc.; and has received consultant’s fees from Marrek, Inc. Dr. Morris has equity interest in Marrek, Inc. Dr. Han has received research grants from Boston Scientific and Abbott. Dr. Steinberg has received research support from Boston Scientific, St. Jude (Abbott), and Janssen; and has been a consultant for Biosense-Webster and Janssen. Dr. Marrouche has received consulting fees from Abbott, Biotronik, Wavelet Health, Cardiac Design, Medtronic, Preventice, Vytronus, Biosense Webster, Marrek, Inc., and Boston Scientific; has received research funding from Abbott, Boston Scientific, GE Healthcare, Siemens, Biotronik, Vytronus, and Biosense Webster; has an ownership interest in Marrek, Inc., and Cardiac Designs; and has conducted contracted research with Biosense Webster, Medtronic, St. Jude Medical, and Boston Scientific. Dr. Chelu has received research funding from Wavelet Health, Biotronik, Medtronic, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received June 3, 2018.
- Revision received July 23, 2018.
- Accepted July 26, 2018.
- 2018 American College of Cardiology Foundation
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