Key result
Posterior wall AI 380 during HPSD is linked to ~98% more esophageal lesions vs 320-350.
Why the study?
The study aimed to evaluate the incidence of ablation-induced endoscopically detected esophageal lesions and gastroparesis in patients undergoing high-power short-duration AF ablation using different target ablation index values.
Does a higher target ablation index (380) compared to lower targets (320 and 350) increase the incidence of esophageal lesions and gastroparesis in patients undergoing high-power short-duration AF ablation?
Cohort (n=233)
Does a higher target ablation index (380) compared to lower targets (320 and 350) increase the incidence of esophageal lesions and gastroparesis in patients undergoing high-power short-duration AF ablation?
Absolute Event Rate: 26% vs 13.1%
p-value: p=0.02
Using a higher target ablation index (380) at the posterior wall during high-power short-duration AF ablation significantly increases the risk of esophageal lesions and gastroparesis compared to lower targets (320 and 350).
Higher posterior wall targets may increase esophageal injury risk in HPSD AF ablation; leaves open optimal index selection.
INTRODUCTION: Aim of this study was to evaluate the incidence of ablation-induced endoscopically detected esophageal lesions (EDEL) and gastroparesis in patients undergoing high-power short-duration (HPSD) atrial fibrillation (AF) ablation using different target ablation index (AI) values. METHODS AND RESULTS: Consecutive patients undergoing AF ablation were included. Radiofrequency (RF) ablation was performed using HPSD ablation (50 W, target AI of 320 and 350 (group 1) and 380 (group 2) at posterior wall). Postablation endoscopy was performed in all patients. In total, 233 patients (66.8 ± 10 years; 52% male) were included consecutively (n = 137 patients in group 1 and n = 96 patients in group 2). Mean AI values und RF time at posterior wall was significantly higher and longer in group 2 compared to group 1 patients (413 ± 9 vs. 392 ± 19 AI, p < 0.01; 9.0 ± 0.8 s vs. 7.8 ± 0.7 s, p < 0.01). Esophageal endoscopy revealed esophageal lesions or gastroparesis in 43 of 233 patients (18.5%) in the total cohort (13.1% in group 1 and 26.0% in group 2; p = 0.02). Incidence of EDEL was 8.0% and 13.5% in group 1 and group 2, respectively. According to logistic analysis incidence of EDEL and/or gastroparesis was significantly lower in patients with a higher body mass index and higher in group 2 patients compared to group 1 patients. CONCLUSION: The incidence of EDEL or gastroparesis in patients undergoing HPSD AF ablation was 18.5% in the total cohort. The risk of EDEL and gastroparesis was associated with a higher AI target value of 380 compared to 320 and 350 at posterior wall and was reversely associated with body mass index.
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List et al. (2022) conducted a cohort in Atrial fibrillation (n=233). Target ablation index (AI) of 380 at posterior wall vs. Target ablation index (AI) of 320 and 350 at posterior wall was evaluated on Esophageal lesions or gastroparesis (p=0.02). A target ablation index of 380 at the posterior wall during HPSD AF ablation was associated with more esophageal lesions or gastroparesis than targets of 320-350 (26.0% vs 13.1%; p=0.02).
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