Esophageal Thermal Injury after Catheter Ablation for Atrial Fibrillation with High-Power (50 Watts) Radiofrequency Energy

Abstract

Background and Objectives Data regarding the safety of atrial fibrillation (AF) ablation using high-power (50 W) radiofrequency (RF) energy in Asian populations are limited. This study was conducted to evaluate the incidence and pattern of esophageal injury after high-power AF ablation in an Asian cohort. Methods We searched the prospective AF ablation registry to identify patients who underwent AF ablation with 50 W RF energy using the smart touch surround flow catheter (Biosense Webster, Diamond Bar, CA, USA). Visitag™ (Biosense Webster) was used for lesion annotation with predefined settings of catheter stability (3 mm for 5 seconds) and minimum contact force (50% of time >5 g). All patients underwent upper gastrointestinal endoscopy at 1 or 3 days after the ablation. Results A total of 159 patients (mean age: 63±9 years, male: 69%, paroxysmal AF: 45.3%, persistent AF: 27.7%, long-standing persistent AF: 27.0%) were analyzed. Initially, 26 patients underwent pulmonary vein isolation with 50 W for 5 seconds at each point. The remaining 133 patients underwent prolonged RF duration (anterior 10 seconds and posterior 6 seconds). The incidence rates of esophageal erythema/erosion and superficial ulceration were 1.3% for each type of the lesion. Food stasis, a suggestive finding of gastroparesis, was observed in 25 (15.7%) patients. There were no cases of cardiac tamponade, stroke, or death. Conclusions In Asian patients, AF ablations using 50 W resulted in very low rates of mild esophageal complications.

Esophageal temperature during atrial fibrillation ablation poorly predicts esophageal injury: An observational study

“…A recent study showed that the incidence of EI, which included erosions and ulcers after ablation, was 1.3% for each type of lesion. 20 EI can range from simple esophageal erosions to the more sinister AEF. EI findings may include gastral erosions (22%), esophageal erythema (21%), gastroparesis (17%), hiatal hernia (16%), reflux esophagitis (12%), thermal esophageal lesion (11%), and suspected Barrett esophagus (5%).…”

“…Esophageal injury during RF ablation is not a rare occurrence. A recent study showed that the incidence of EI, which included erosions and ulcers after ablation was 1.3% for each type of lesion respectively (23). EI can range from simple esophageal erosions to the more sinister atrio-esophageal (AE) fistula.…”

Acute and long‐term efficacy of ablation index‐guided higher power shorter duration ablation in patients with atrial fibrillation: A prospective registry

“…PVI with high power (50 W) short duration was effective and safe with shortened procedure time compared to conventional power PVI 27 . In one recent study, 1.3% of esophageal erythema, 1.3% of esophageal erosion, and 15.7% of gastroparesis were reported after PVI with 50 W for 10 seconds at anterior and 50 W for 6 seconds at posterior wall 28 . Although several studies applied 50W as a high power PVI, it can still be questionable about safety, especially at the posterior wall.…”

“… 27 In one recent study, 1.3% of esophageal erythema, 1.3% of esophageal erosion, and 15.7% of gastroparesis were reported after PVI with 50 W for 10 seconds at anterior and 50 W for 6 seconds at posterior wall. 28 Although several studies applied 50W as a high power PVI, it can still be questionable about safety, especially at the posterior wall. Our study demonstrated the comparable efficacy and safety of higher power ablation (40 W at anterior and 30 W at posterior) compared to conventional power ablation (30 W at anterior and 25 W at posterior) using the same targeted AI (450 at anterior and 350 at posterior) in both groups.…”

Esophageal Endoscopy after High-power and Short-duration Ablation in Atrial Fibrillation Patients

“…In a recent article in the Korean Circulation Journal , Do et al 8) evaluated the incidence and characteristics of ETI in 196 patients underwent HPSD ablation (RF energy setting: 50W for 5 seconds or 50W for 10 seconds at anterior and 6 seconds at posterior). Their results showed that only 4 (2.5%) patients had ETI including erythematous erosion or superficial ulcer of the esophagus and 25 (15.7%) patients had gastric hypo-motility.…”