Key result
CLOSE-guided 50W HPSD PVI yields ~12% esophageal lesion rate with no perforations or fistulas.
Why the study?
While short-term to midterm efficacy and efficiency of HPSD RF PVI for AF are promising, esophageal safety using an optimized ablation approach needed investigation.
Does CLOSE-guided 50 W high-power-short-duration PVI result in a low incidence of endoscopically detected esophageal lesions in patients undergoing first-time AF ablation?
Cohort (n=300)
No
Does CLOSE-guided 50 W high-power-short-duration PVI result in a low incidence of endoscopically detected esophageal lesions in patients undergoing first-time AF ablation?
CLOSE-guided 50 W high-power-short-duration PVI demonstrates a low incidence of severe esophageal lesions, suggesting it is a safe approach when posterior wall catheter contact force is kept below 15 g.
Supports low severe esophageal injury risk with CLOSE-guided 50 W HPSD PVI under contact force limits; hypothesis-generating, needs randomized confirmation.
INTRODUCTION: Pulmonary vein isolation (PVI) using high-power-short-duration (HPSD) radiofrequency ablation (RF) is emerging as the standard of care for treatment of atrial fibrillation (AF). While procedural short-term to midterm efficacy and efficiency are very promising, this registry aims to investigate esopahgeal safety using an optimized ablation approach. METHODS: In a single-center experience, 388 consecutive standardized first-time AF ablation were performed using a CLOSE-guided-fixed-50 W-circumferential PVI and substrate modification without intraprocedural esophageal temperature measurement. Three hundred patients underwent postprocedural esophageal endoscopy to diagnose and grade endoscopically detected esophageal lesions (EDEL) and were included in the analysis. RESULTS: EDEL were detected in 35 of 300 patients (11.6%), 25 of 35 were low-grade Kansas-city-classification (KCC) 1 lesions with fast healing tendencies. Six patients suffered KCC 2a lesions, 4 patients had KCC 2b lesions (1.3% of all patients). No esophageal perforation or fistula formation was observed. Patient baseline characteristics, especially patients age, gender, and body mass index did not influence EDEL incidence. Additional posterior box isolation did not increase the incidence of EDEL. In patients diagnosed with EDEL, mean catheter contact force during posterior wall ablation was higher (11.9 ± 1.8 vs. 14.7 ± 3 g, p < .001), mean RF duration was shorter (11.9 ± 1 vs. 10.7 ± 1.2 s, p < .001), while achieved ablation index was not different between groups (434 ± 4.9 vs. 433 ± 9.5, n.s.). CONCLUSION: Incidence of EDEL after CLOSE-guided-50 W-HPSD PVI is lower compared to historical cohorts using standard-power RF settings. Catheter contact force during posterior HPSD ablation should not exceed 15 g.
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Francke et al. (2022) conducted a cohort in Atrial fibrillation (n=300). CLOSE-guided high-power-short-duration pulmonary vein isolation was evaluated on Endoscopically detected esophageal lesions (EDEL). CLOSE-guided 50 W high-power-short-duration pulmonary vein isolation resulted in endoscopically detected esophageal lesions in 11.6% of patients, with no perforations or fistulas observed.
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