Incidence of ablation‐induced esophageal injury associated with high‐power short duration temperature‐controlled pulmonary vein isolation using a specialized open‐irrigated ablation catheter: A retrospective single‐center study

Abstract

Introduction To evaluate short‐term efficacy and incidence of ablation‐induced endoscopically detected esophageal injury in patients undergoing high‐power, short‐duration (HPSD) pulmonary vein isolation using a novel irrigated radiofrequency ablation catheter and ablation generator setup. Methods and Results Atrial fibrillation (AF) patients, who underwent AF ablation using an irrigated radiofrequency ablation catheter specifically designed for a HPSD ablation approach (50 W, with a target Ablation Index of 350 at posterior wall), received postablation esophageal endoscopy after ablation. In total 45 consecutive patients (67 ± 10 years; 58% male; 42% paroxysmal AF) undergoing AF ablation using a specialized ablation catheter (QDOT) were included in the study. Thirty‐one of 45 patients (69%) underwent a first‐time pulmonary vein isolation (Group 1, 67 ± 11 years; 55% male; 48% paroxysmal AF). Fourteen patients (31%) underwent a redo AF procedure (Group 2, 66 ± 8 years; 64% male; 29% paroxysmal AF). Patients undergoing first‐time pulmonary vein isolation were included in the final analysis. In these patients an endoscopically detected esophageal lesion (EDEL) was detected in 5 of 31 (16%) patients (erosion n = 2, ulcer n = 3). Mean contact force at posterior wall ablation sites was significantly lower in patients with postprocedural EDEL compared with patients without EDEL (11.9 ± 0.8 g vs. 15.6 ± 4.7 g). Conclusion PVI using a specialized high‐power ablation catheter in conjunction with a HPSD ablation approach results in a 16% incidence of EDEL in first AF ablation candidates. Future studies evaluating high‐power short duration ablation strategies should include esophageal endoscopy to estimate the risk of clinically relevant esophageal complications.

Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study

“…Since a Teso probe temperature rise was detected in 39% of patients we strongly suggest to use Teso probes and predefined temperature cut off values to avoid esophageal injuries. A recent study utilizing the Qmode of the QDOT Micro catheter with a 50 W HP-SD protocol results in a 16% incidence of ablation‐induced esophageal injuries [17] . In our study no charring, no steam pops and no clinical apparent esophageal injuries occurred, suggesting an excellent safety profile of the QMODE+ ablation mode.…”

Characterization of high‐power and very‐high‐power short‐duration radiofrequency lesions performed with a new‐generation catheter and a temperature‐control ablation mode

“…For HPSD lesions, the temperature‐controlled QMODE algorithm is used, which modulates irrigation rate (first) and power (afterward, if irrigation rate increase is not enough) based on temperature, allowing for the creation of lesions of up to 50 W. The information is also integrated into the electromagnetic location technology of CARTO3® mapping system (Biosense Webster Inc). Although not developed or validated for QDot‐Micro catheter, AI can be calculated for applications performed with the QMODE algorithm (but not whit QMODE+), and some groups have tested its clinical performance, with good results 11–13 . We employed the same AI objectives that have been proposed for left atrial posterior (400) or anterior (550) wall ablation when using QDot‐Micro for conventional to high‐power lesions (up to 50 W).…”

Novel concepts in atrial fibrillation ablation—breaking the trade‐off between efficacy and safety

“…Even though in clinical data generated so far there is no signal for an excess in any complication like cardiac tamponade or stroke, the potential risk of steam pop and thrombus formation with high power RF applications remains a concern. Moreover, despite a theoretically more favorable lesion geometry, serious esophageal injury did still occur in clinical trials investigating HPSD ablation, 19 and according to a recent report, the incidence of esophageal lesions may be substantially higher than suggested by some of the above‐mentioned trials 22 . This may reflect the narrower safety margin when applying RF at high or very high power, where only slightly superoptimal RF application times can already constitute a substantial overshoot resulting in serious complications 13 .…”