scholarly journals Characteristics of Esophageal Injury in Ablation of Atrial Fibrillation Using a High-Power Short-Duration Setting

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Takashi Kaneshiro ◽  
Masashi Kamioka ◽  
Naoko Hijioka ◽  
Shinya Yamada ◽  
Tetsuro Yokokawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Thermal Injury ◽  
Low Voltage ◽  
Conventional Group ◽  
Esophageal Injury

Background: The mechanism of esophageal thermal injury (ETI; esophageal mucosal injury and periesophageal nerve injury leading to gastric hypomotility) remains unknown when using a high-power short-duration (HP-SD) setting. This study sought to evaluate the characteristics of esophageal injuries in atrial fibrillation ablation using a HP-SD setting. Methods: After exclusion of 5 patients with their esophagus at the right portion of left atrium and 21 patients with additional ablations such as box isolation and low voltage area ablation in left atrium posterior wall, 271 consecutive patients (62±10 years, 56 women) who underwent pulmonary vein isolation by radiofrequency catheter ablation were analyzed. In the 101 patients, a HP-SD setting at 45 to 50 W with an Ablation Index module was used (HP-SD group). In the remaining 170 patients before introduction of the HP-SD setting, a conventional power setting of 20 to 30 W with contact force monitoring was used (conventional group). We performed esophagogastroduodenoscopy after pulmonary vein isolation in all patients and investigated the incidence and characteristics of ETI. Results: Although the incidence of ETI was significantly higher in the HP-SD group compared with the conventional group (37% versus 22%, P =0.011), the prevalence of esophageal lesions did not differ between the groups (7% versus 8%). Multivariate logistic regression analysis revealed that the use of the HP-SD setting (odds ratio, 6.09, P <0.001), and the parameters that suggest anatomic proximity surrounding the esophagus, were independent predictors of ETI. However, the majority of ETI in the HP-SD group was gastric hypomotility, and the thermal injury was limited to the shallow layer of the periesophageal wall using the HP-SD setting. Conclusions: Although the use of the HP-SD setting was a strong predictor of ETI, it could avoid deeper thermal injuries that reach the esophageal mucosal layer.

Impact of High-Power Short-Duration Radiofrequency Ablation on Esophageal Temperature Dynamic

2021 ◽  
Author(s):  
Hagai D. Yavin ◽  
Zachary P. Bubar ◽  
Koji Higuchi ◽  
Jakub Sroubek ◽  
Mohamed Kanj ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Temperature Rise ◽  
Esophageal Injury ◽  
Esophageal Temperature ◽  
Dynamic Profile ◽  
Temperature Dynamic

Background: High-power short-duration (HP-SD) radiofrequency ablation (RFA) has been proposed as a method for producing rapid and effective lesions for pulmonary vein isolation. The underlying hypothesis assumes an increased resistive heating phase and decreased conductive heating phase, potentially reducing the risk for esophageal thermal injury. The objective of this study was to compare the esophageal temperature dynamic profile between HP-SD and moderate-power moderate-duration (MP-MD) RFA ablation strategies. Methods: In patients undergoing pulmonary vein isolation, RFA juxtaposed to the esophagus was delivered in an alternate sequence of HP-SD (50 W, 8–10 s) and MP-MD (25 W, 15–20 s) between adjacent applications (distance, ≤4 mm). Esophageal temperature was recorded using a multisensor probe (CIRCA S-CATH). Temperature data included magnitude of temperature rise, maximal temperature, time to maximal temperature, and time return to baseline. In swine, a similar experimental design compared the effect of HP-SD and MP-MD on patterns of esophageal injury. Results: In 20 patients (68.9±5.8 years old; 60% persistent atrial fibrillation), 55 paired HP-SD and MP-MD applications were analyzed. The esophageal temperature dynamic profile was similar between HP-SD and MP-MD ablation strategies. Specifically, the magnitude of temperature rise (2.1 °C [1.4–3] versus 2.0 °C [1.5–3]; P =0.22), maximal temperature (38.4 °C [37.8–39.3] versus 38.5 °C [37.9–39.4]; P =0.17), time to maximal temperature (24.9±7.5 versus 26.3±6.8 s; P =0.1), and time of temperature to return to baseline (110±23.2 versus 111±25.1 s; P =0.86) were similar between HP-SD and MP-MD ablation strategies. In 6 swine, esophageal injury was qualitatively similar between HP-SD and MP-MD strategies. Conclusions: Esophageal temperature dynamics are similar between HP-SD and MP-MD RFA strategies and result in comparable esophageal tissue injury. Therefore, when using a HP-SD RFA strategy, the shorter application duration should not prompt shorter intervals between applications.

Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation

EP Europace ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 388-393 ◽  
Author(s):  
Marc Kottmaier ◽  
Miruna Popa ◽  
Felix Bourier ◽  
Tilko Reents ◽  
Jairo Cifuentes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Paroxysmal Atrial Fibrillation ◽  
Pericardial Tamponade ◽  
Standard Group ◽  
Short Period ◽  
Procedural Time

Abstract Aims Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) in patients with paroxysmal atrial fibrillation (PAF) is effective but hampered by pulmonary vein reconnection due to insufficient ablation lesions. High-power delivery over a short period of time (HPSD) in RFA is stated to create more efficient lesions. The aim of this study was to compare intraprocedural safety and outcome of HPSD ablation to conventional power settings in patients undergoing PVI for PAF. Methods and results We included 197 patients with PAF that were scheduled for PVI. An ablation protocol with 70 W and a duration cut-off of 7 s at the anterior left atrium (LA) and 5 s at the posterior LA (HPSD group; n = 97) was compared to a conventional power protocol with 30–40 W for 20–40 s (standard group; n = 100) in terms of periprocedural complications and a 1-year outcome. The HPSD group showed significantly less arrhythmia recurrence during 1-year follow-up with 83.1% of patients free from atrial fibrillation compared to 65.1% in the standard group (P &lt; 0.013). No pericardial tamponade, periprocedural thromboembolic complications, or atrio-oesophageal fistula occurred in either group. Mean radiofrequency time (12.4 ± 3.4 min vs. 35.6 ± 12.1 min) and procedural time (89.5 ± 23.9 min vs. 111.15 ± 27.9 min) were significantly shorter in the HPSD group compared to the standard group (both P &lt; 0.001). Conclusion High-power short-duration ablation demonstrated a comparable safety profile to conventional ablation. High-power short-duration ablation using 70 W for 5–7 s leads to significantly less arrhythmia recurrences after 1 year. Radiofrequency and procedural time were significantly shortened.

Pulmonary vein isolation for paroxysmal atrial fibrillation using high-power short duration radiofrequency or second-generation cryoballoon ablation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Kardos ◽  
K Kassa ◽  
Z Nagy ◽  
Z Kis ◽  
D Simkovits ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Tissue Loss ◽  
Transport Function ◽  
Hs Crp

Abstract Funding Acknowledgements Type of funding sources: None. Background Differences in the left atrial (LA) tissue loss can occur following different pulmonary vein isolation (PVI) techniques. Purpose Our prospective study compared the biomarker, the LA mechanical, and the electrophysiological findings as indicators of LA myocardial damage after a high-power short duration  (HPSD) with contact force radiofrequency catheter and second-generation cryoballoon (CB2) ablation of paroxysmal atrial fibrillation (AF). Methods :We enrolled 40 patients with paroxysmal AF [16 (40%) women, mean age = 55.9 ± 12.4 years] who underwent HPSD (n = 21) or CB2 (n = 19). Biomarker levels (hs-cTnT, CK-MB, hs-CRP, LDH) and the transport function of the LA by transthoracic echocardiography (TTE) were compared pre and post procedurally. High-density mapping (HDM) was performed in sinus rhythm using a multielectrode diagnostic catheter in each group to define isolated left atrial low voltage area (LVA; &lt;0.2mV in bipolar voltage mapping).  LA CT-angiography and HDM merge was used to calculate the post-PVI LVA and the LVA/LA surface ratio. Results Postablation hs-cTnT and hs-CRP levels were comparable in the ablation groups (HPSD: 1249 ± 469 and 9.53 ± 10.30 vs. CB2: 995 ± 280 and 12.36 ± 5.76, p = 0.065 and p = 0.732), while CK-MB and LDH levels were significantly higher following CB2 ablation (HPSD: 6.61 ± 2.62 and 349.9 ± 65.6 vs. CB2: 26.01 ± 6.88 and 451.6 ± 91.3, p &lt; 0.001 and p &lt; 0.001). The transport function of the LA did not change significantly by TTE after the procedure. Fractional Area Change at baseline and 3 months was 33.9 ± 13.8 and 33.5 ± 10.7  p = 0.9 in the HPSD group while 38.1 ± 8.6 and 35.3 ± 12.2 p = 0.9 in the CB2 group.  LA Ejection Fraction measured in the two groups (before and 3-month post-procedure): HPSD: 51.2 ± 20.5% and 49.5 ± 14.7%, p = 0.9, CB2: 49.7 ± 15.5% and 50.7 ± 13.3%, p = 0.8). Ablation time was comparable in the two groups (HPSD: 1676 ± 570 sec, CB2: 1495 ± 494 sec, p = 0.279), while fluoroscopy time and radiation exposure were significantly higher in the CB2 group (HPSD: 5.62 ± 4.31 min and 232 ± 406 cGycm2, CB2: 13.65 ± 5.18 min and 1819 ± 1669 cGycm2, p &lt;0.001 and p &lt;0.001). The LVA/LA surface ratio were: HPSD group: 8.37 ± 6.42% and CB2 group: 13.58 ± 8.92% (p = 0.007). At 12-month follow-up, the success rate, defined as freedom from AF/atrial tachycardia without antiarrhythmic drug was 80.1% (HPSD) and 84.2% (CB2) respectively. Conclusions The LA scar tissue was significantly higher following CB2 ablation, but did not affect medium-term efficacy. However, tissue loss did not reduce the transport function of the LA.

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