Key result
60 W QMODE+ radiofrequency application achieved comparable rates of periesophageal residual conduction gaps (8.3% vs 11.5%) and esophageal lesions (4.2% vs 4.2%) compared to 90 W application.
Why the study?
Does 60 W compared to 90 W very high-power short-duration radiofrequency application improve safety and efficacy in the periesophageal region during pulmonary vein isolation in patients with atrial fibrillation?
RCT (n=50)
Single-blind
Minimization method
No
Does 60 W compared to 90 W very high-power short-duration radiofrequency application improve safety and efficacy in the periesophageal region during pulmonary vein isolation in patients with atrial fibrillation?
In a pilot study of AF patients undergoing pulmonary vein isolation, 60 W and 90 W very high-power short-duration RF applications to the periesophageal region resulted in comparable rates of acute conduction block and esophageal injury, though contact force was significantly higher in the 60 W group.
Answers are grounded in this paper and cite their sources.
60 W and 90 W yield comparable periesophageal safety; extends very high-power short-duration options while leaving long-term efficacy open in larger trials.
Background In very high‐power (51–90 W), short‐duration (4 s) radiofrequency applications (QMODE+) using the QDOT MICRO catheter, the optimal power setting at the left atrial (LA) posterior wall adjacent to the esophagus for treating atrial fibrillation (AF) remains unclear. Objective We evaluated the efficacy and safety of 60 W versus 90 W QMODE+ radiofrequency applications in the periesophageal region. Methods Fifty AF patients were randomized into two groups based on the QMODE+ power applied to the periesophageal region: 60 W ( n = 24) and 90 W ( n = 26). We compared the incidence of residual conduction gaps in the periesophageal region and endoscopic esophageal lesions, as well as the 1‐year atrial tachyarrhythmia (AT) recurrence rate between the two groups. Results Median contact force was significantly higher in the 60 W group than in the 90 W group (12.9 g [ IQR 10.2, 15.8] in the 60 W group and 10.9 g [ IQR 8.4, 14.2] in the 90 W group, p < 0.001). The rates of residual conduction gaps (8.3% and 11.5%, respectively, p = 1.00) and esophageal lesions (4.2% in each group) were similar between the two groups. The 1‐year AT recurrence rate did not significantly differ between the two groups (20.8% vs. 7.7%, respectively, p = 0.24). Conclusion 60 W and 90 W QMODE+ RF applications for the periesophageal region achieved comparable rates of acute conduction block, endoscopy‐detected esophageal injury, and 12‐month AT recurrence‐free survival, although contact force was significantly higher in the 60 W group. Trial Registration Japan Registry of Clinical Trials (jRCT); jRCT1072230115 (Registered on February 8, 2024)
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Okamatsu et al. (2026) conducted an RCT in Atrial fibrillation (n=50). 60 W QMODE+ radiofrequency application vs. 90 W QMODE+ radiofrequency application was evaluated on Incidence of residual conduction gaps in the periesophageal region (p=1.00). 60 W QMODE+ radiofrequency application achieved comparable rates of periesophageal residual conduction gaps (8.3% vs 11.5%) and esophageal lesions (4.2% vs 4.2%) compared to 90 W application.
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