Author + information
- Received December 16, 2019
- Revision received May 4, 2020
- Accepted May 18, 2020
- Published online August 12, 2020.
- Shaojie Chen, MD, PhDa,b,∗ ( )(, )
- K.R. Julian Chun, MDa,c,∗ (, )
- Shota Tohoku, MDa,
- Stefano Bordignon, MDa,
- Lukas Urbanek, MDa,
- Franziska Willems, MDa,
- Karin Plank, MDa,
- Max Hilbert, MDa,
- Athanasios Konstantinou, MDa,
- Nikolaos Tsianakas, MDa,
- Fabrizio Bologna, MDa,
- Claudia Kreuzer, MDa,
- Luca Trolese, MDa and
- Boris Schmidt, MDa,∗ ()
- aCardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany
- bDie Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
- cMedizinische Klinik II, Kardiologie/Angiologie/Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Universität zu Lübeck, Lübeck, Germany
- ↵∗Address for correspondence:
Dr. Shaojie Chen, Dr. K.R. Julian Chun, or Dr. Boris Schmidt, Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Wilhelm-Epstein Strasse 4, 60431 Frankfurt am Main, Germany.
Objectives This study sought to investigate the safety profile of a novel ablation index–guided high-power short-duration (AI-HP) pulmonary vein isolation (PVI) in terms of endoscopic esophageal lesions.
Background The risk of esophageal injury during PVI is a major concern while ablating the posterior wall for patients with atrial fibrillation. Luminal esophageal temperature (LET) rise during ablation is a surrogate for esophageal lesion development.
Methods 122 consecutive symptomatic atrial fibrillation patients underwent AI-HP PVI (50 W throughout the ablation, AI anterior wall/posterior wall 550/400). All patients were under LET monitoring (cutoff LET 39°C) during the ablation procedure, and patients with LET rise received esophageal endoscopy examination 1 to 3 days after the ablation. Ablation lesion data of the sites with LET rise were analyzed.
Results Procedural PVI success rate was 100%. Per procedure, the mean radiofrequency ablation time, procedural time, and fluoroscopic time were 11.9 ± 2.7 min, 54.8 ± 9 min, and 5.5 ± 1.6 min. The incidence of LET >39°C was 47%, and the mean peak LET was 41.2 ± 1.8°C. The rate of endoscopic detected lesion was 2 of 57 (3.5%). No perforation or atrial-esophageal fistula was found. The mean contact force, application duration, impedance drop, and AI values at the sites with LET rise were 22.1 ± 8.9 g, 7 ± 2.4 s, 9.4 ± 4.6 Ω, and 419 ± 44.6.
Conclusions AI-HP (50 W) ablation appears to be a highly efficient ablation technique for PVI. The incidence of esophageal injury during AI-HP PVI seems markedly low. AI-HP ablation targeting AI 400 in combination with multisensor esophageal temperature monitoring for the left atrial posterior wall appears safe and efficient.
Drs. Chen, Chun, and Schmidt have been consultants to Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 December 16, 2019.
- Revision received May 4, 2020.
- Accepted May 18, 2020.
- 2020 American College of Cardiology Foundation
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