Higher power short duration ablation resulted in a similar incidence of oesophageal thermal injury compared to lower power longer duration ablation (4.5% vs 4.5%, P=1.0).
RCT (n=88)
1:1
Yes
Does higher power short duration (HPSD) ablation reduce oesophageal thermal injury in patients with atrial fibrillation undergoing PVI compared to lower power longer duration (LPLD) ablation?
Higher power short duration ablation for pulmonary vein isolation is safe with similar rates of oesophageal thermal injury compared to lower power longer duration ablation, but offers shorter procedure times and potentially lower atrial fibrillation recurrence.
Absolute Event Rate: 4.5% vs 4.5%
p-value: p=1.0
AIMS: Radiofrequency (RF) ablation for pulmonary vein isolation (PVI) in atrial fibrillation (AF) is associated with the risk of oesophageal thermal injury (ETI). Higher power short duration (HPSD) ablation results in preferential local resistive heating over distal conductive heating. Although HPSD has become increasingly common, no randomized study has compared ETI risk with conventional lower power longer duration (LPLD) ablation. This study aims to compare HPSD vs. LPLD ablation on ETI risk. METHODS AND RESULTS: Eighty-eight patients were randomized 1:1 to HPSD or LPLD posterior wall (PW) ablation. Posterior wall ablation was 40 W (HPSD group) or 25 W (LPLD group), with target AI (ablation index) 400/LSI (lesion size index) 4. Anterior wall ablation was 40-50 W, with a target AI 500-550/LSI 5-5.5. Endoscopy was performed on Day 1. The primary endpoint was ETI incidence. The mean age was 61 ± 9 years (31% females). The incidence of ETI (superficial ulcers n = 4) was 4.5%, with equal occurrence in HPSD and LPLD (P = 1.0). There was no difference in the median value of maximal oesophageal temperature (HPSD 38.6°C vs. LPLD 38.7°C, P = 0.43), or the median number of lesions per patient with temperature rise above 39°C (HPSD 1.5 vs. LPLD 2, P = 0.93). Radiofrequency ablation time (23.8 vs. 29.7 min, P < 0.01), PVI duration (46.5 vs. 59 min, P = 0.01), and procedure duration (133 vs. 150 min, P = 0.05) were reduced in HPSD. After a median follow-up of 12 months, AF recurrence was lower in HPSD (15.9% vs. LPLD 34.1%; hazard ratio 0.42, log-rank P = 0.04). CONCLUSION: Higher power short duration ablation was associated with similarly low rates of ETI and shorter total/PVI RF ablation times when compared with LPLD ablation. Higher power short duration ablation is a safe and efficacious approach to PVI.
Chieng et al. (Fri,) conducted a rct in Atrial fibrillation (n=88). Higher power short duration (HPSD) posterior wall ablation vs. Lower power longer duration (LPLD) posterior wall ablation (25 W) was evaluated on Oesophageal thermal injury (ETI) incidence (p=1.0). Higher power short duration ablation resulted in a similar incidence of oesophageal thermal injury compared to lower power longer duration ablation (4.5% vs 4.5%, P=1.0).