What question did this study set out to answer?

To compare the incidence of esophageal heating and procedural success across ablation protocols combining different radiofrequency power levels and target lesion size index values on the posterior left atrial wall.

September 8, 2020Circulation Arrhythmia and ElectrophysiologyOpen Access

Power, Lesion Size Index and Oesophageal Temperature Alerts During Atrial Fibrillation Ablation

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Why the study?

Low radiofrequency powers require longer ablation durations to achieve a target LSI and may cause conductive esophageal heating, prompting evaluation of higher versus lower power protocols.

Does 40 W radiofrequency power compared to 20 W power reduce esophageal temperature alerts and improve procedural success in patients undergoing atrial fibrillation ablation?

Comparison

4 combinations of RF power and target LSI (20 W/LSI 4, 20 W/LSI 5, 40 W/LSI 4, and 40 W/LSI 5)

Design

Prospective randomized study

Follow-up

29 months

Authors

MLMilena LeoElectrophysiology MPMichala PedersenJohn Radcliffe Hospital KRKim RajappanElectrophysiology

Discussion

Member takes

Implication

Low-power posterior wall ablation may reduce esophageal risk but requires validation; leaves open optimal LSI-guided strategies in larger trials.

Key Points

To compare the incidence of esophageal heating and procedural success across ablation protocols combining different radiofrequency power levels and target lesion size index values on the posterior left atrial wall.
Prospective randomized clinical trial enrolling 80 consecutive patients undergoing atrial fibrillation ablation (NCT02619396).
Patients were randomized to 4 left atrial posterior wall ablation protocols: 20 W/LSI 4, 20 W/LSI 5, 40 W/LSI 4, and 40 W/LSI 5.
The primary endpoint was the occurrence and frequency of esophageal temperature alerts, with secondary endpoints evaluating acute pulmonary vein isolation and recurrence at 29-month follow-up.
Esophageal temperature alerts occurred in a similar proportion of patients across all four groups, with significantly shorter radiofrequency delivery times required in the 40 W arms.
Fewer than 50% of lesions achieved the target LSI of 5 in the 20 W group, which also exhibited lower first-pass pulmonary vein isolation and higher acute reconnection rates.
Patients in the 40 W ablation groups experienced a lower rate of atrial fibrillation recurrence compared with the 20 W groups over a 29-month follow-up period.

Structured PICO

Does 40 W radiofrequency power compared to 20 W power reduce esophageal temperature alerts and improve procedural success in patients undergoing atrial fibrillation ablation?

Population

80 consecutive patients undergoing atrial fibrillation ablation

Intervention

Radiofrequency ablation on the left atrium posterior wall using 40 W power (target lesion size index [LSI] 4 or 5)

Comparator

Radiofrequency ablation on the left atrium posterior wall using 20 W power (target lesion size index [LSI] 4 or 5)

Outcome

Occurrence and number of esophageal temperature alerts per patient during ablationsafety

Posterior wall ablation with 40 W is associated with similar esophageal temperature alerts but lower AF recurrence at 29 months compared to 20 W.

Cite This Study

Leo et al. (2020) studied this question.

synapsesocial.com/papers/6a74294bc64913a07da7f550 https://doi.org/10.1161/circep.120.008316

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes

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Implication

Low-power posterior wall ablation may reduce esophageal risk but requires validation; leaves open optimal LSI-guided strategies in larger trials.

Power, Lesion Size Index and Oesophageal Temperature Alerts During Atrial Fibrillation Ablation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Power, Lesion Size Index and Oesophageal Temperature Alerts During Atrial Fibrillation Ablation

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider