Why the study?
In PVI using high-power short-duration ablation, no consensus exists regarding optimal radiofrequency application settings in the left atrium adjacent to the esophagus.
Does high-power short-duration (50 W for 5 s) radiofrequency ablation on the esophageal area during pulmonary vein isolation maintain efficacy and prevent esophageal thermal injury?
Does high-power short-duration (50 W for 5 s) radiofrequency ablation on the esophageal area during pulmonary vein isolation maintain efficacy and prevent esophageal thermal injury?
High-power short-duration (50 W for 5 s) ablation on the esophageal area during PVI is highly effective (96.5% conduction block) with a low incidence of mucosal injury, though right-sided and repeated applications increase thermal injury risk.
High-power short-duration ablation near the esophagus may be feasible during PVI; leaves open thermal injury risk with repeated or right-sided applications.
BACKGROUND: In pulmonary vein isolation (PVI) employing a high-power and short-duration (HP-SD) strategy, no consensus exists regarding the optimal settings for radiofrequency application (RFA) to the section of left atrium adjacent to the esophagus (esophageal area, EA). OBJECTIVE: To evaluate (1) the efficacy and safety of HP-SD RFA with 50 W for 5 s on the EA, and (2) the predictive factors of esophageal thermal injury (ETI). METHODS: We performed esophagogastroduodenoscopy on 85 patients who had undergone PVI with 50 W RFA. RFA duration was limited to 5 s on the EA. RESULTS: Of the 85 patients, 16 (18.8%) developed asymptomatic thermal injury (1 mucosal injury, namely erosion and 15 gastric hypomotility). All of those were asymptomatic and transient, and any symptomatic or severe, esophageal or gastric complications was not observed. On the EA, conduction block was achieved after the first encircling in 82 (96.5%) patients. The number of RFA on the EA and the proportion of patients whose EA was located at the posterior wall of the right inferior PV (right-sided EA) were higher in the patients with ETI than without (9.0 [7.0-10.5] vs. 7.0 [5.0-9.0] p = 0.021, and 18.8% vs. 2.9%, p = 0.044, respectively). In multivariate analysis, the number of RFA on the EA (hazard ratio 1.32, p = 0.019) and RFA on the right-sided EA (hazard ratio, 13.50, p = 0.013) were identified as the predictors of ETI. CONCLUSION: RFA of 50 W for 5 s on the EA can be performed with a low incidence of esophageal mucosal injury while maintaining efficacy. RFA on the right-sided EA and the high number of RFA on the EA increase the risk of ETI.
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Sato et al. (2025) studied this question.
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