Key result
An ablation index target of 350 at the posterior wall during AF ablation reduced the incidence of esophageal injury compared to a target of 400 (3.3% vs 26.7%, P=0.03).
Why the study?
During AF ablation, energy delivery toward the left atrial posterior wall may cause esophageal injury, but the impact of ablation index technology on this risk has not been explored.
Does an ablation index target value of 350 reduce esophageal thermal injury compared to 400 in patients with paroxysmal AF undergoing first-time ablation?
Cohort (n=60)
Does an ablation index target value of 350 reduce esophageal thermal injury compared to 400 in patients with paroxysmal AF undergoing first-time ablation?
Absolute Event Rate: 3.3% vs 26.7%
p-value: p=.03
Using a lower ablation index target of 350 at the posterior wall during AF ablation significantly reduces the risk of esophageal thermal injury without compromising acute procedural success.
May reduce esophageal injury with lower AI targets; hypothesis-generating pending randomized confirmation.
BACKGROUND: During ablation for atrial fibrillation (AF), energy delivery toward the left atrial posterior wall may cause esophageal injury (EI). Ablation index (AI) was introduced to estimate ablation lesion size, however, the impact of AI technology on the risk of EI has not been explored. METHOD: From March 2019 to December 2019, 60 patients with paroxysmal AF undergoing first-time ablation were prospectively enrolled. The first 30 consecutive patients were ablated with the AI target value of 400 (AI-400 group), and the later 30 consecutive patients were ablated with the AI target value of 350 at the posterior wall (AI-350 group). Endoscopic ultrasonography was used to evaluate EI postablation. EI was classified as a category 1 (erythema or erosion) or a category 2 (hematoma or ulceration). RESULTS: Compared with the AI-400 group (59.9 ± 8.4 years; male, 60%), the AI-350 group (59.1 ± 9.9 years; male, 50%) had a lower incidence of EI (3.3% vs 26.7%, P = .03). There was no significant difference in the percentage of first-pass PVI between the AI-400 group and the AI-350 group (left PVI: 80% vs 73.4%, P = .54; right PVI: 80% vs 60%, P = .1). Neither ablation time nor fluoroscopy time was significantly different between the AI-400 group and the AI-350 group. CONCLUSIONS: AF ablation guide by AI target value of 350 may reduce esophageal thermal injury and has a similar efficiency on the acute success rate of first-pass PVI compared with an AI target value of 400 at the posterior wall.
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Zhang et al. (2020) conducted a cohort in Paroxysmal atrial fibrillation (n=60). Ablation index target value of 350 vs. Ablation index target value of 400 was evaluated on Incidence of esophageal injury (p=.03). An ablation index target of 350 at the posterior wall during AF ablation reduced the incidence of esophageal injury compared to a target of 400 (3.3% vs 26.7%, P=0.03).
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