Catheter ablation of atrial fibrillation using ablation index–guided high power (50 W) for pulmonary vein isolation with or without esophageal temperature probe (the AI-HP ESO II)

Self Cite

Background Radiofrequency (RF) high‐power ablation appears to be a novel concept in treating atrial fibrillation (AF). The ablation‐index (AI) has been linked with the durability of pulmonary vein isolation (PVI). To report the midterm clinical results of a new ablation strategy using AI‐guided high‐power (50 W) ablation (AI‐HP). Methods and Results Symptomatic AF patients were included and underwent wide‐area circumferential PVI. Contact‐force catheters were used, RF power was set to 50 W targeting AI values (550/400 for anterior/posterior) and interlesion distance 6 mm. Luminal esophageal temperature (LET) was monitored during the procedure; patients with LET ≥39°C underwent post‐ablation esophageal‐endoscopy. Seventy‐two‐hour‐Holter ECGs were scheduled during follow‐up. Procedural PVI was achieved in all (N = 122; mean age, 68.2 years; male, 71.3%) patients, rate of first‐pass PVI was 96.7% per patient. Procedural mean RF time was 11.5 min, and mean RF time during posterior wall segment was 3.1 min. Per RF‐lesion, the mean contact force, RF duration, AI, and impedance‐drop at anterior/posterior wall were 26 ± 14 g/23 ± 12 g, 16.2 ± 7.5 s/8.8 ± 3.6 s, 552 ± 53/438 ± 47, and 13 ± 6 Ω/9 ± 5 Ω, respectively. Mean PVI procedural‐time, 55.8 min; mean procedural fluoroscopic time, 5.6 min. Three (2.5%) patients had asymptomatic endoscopic small erosion/erythema esophageal lesions, no serious adverse events were observed. During a 15‐month follow‐up, overall single‐procedure freedom from clinical recurrence of AF/atrial tachycardia (AT) off antiarrhythmic drug after blanking period was 85.2% (89.4% for paroxysmal AF, 80.4% for persistent AF). Conclusion The AI‐HP (50 W) appears as an efficient ablation technique in treating AF and leads to a high single‐procedure arrhythmia‐free survival at 15 months.

Section: Discussionmentioning

confidence: 73%

Catheter ablation of atrial fibrillation using ablation index‐guided high‐power technique: Frankfurt AI high‐power 15‐month follow‐up

Chen

Schmidt

Bordignon

et al. 2021

Self Cite

“…The high‐power ablation strategy has demonstrated in animal models 15 to create lesions that are similar in volume, but broader and less deep compared with standard power and duration because high‐power heating causes immediate and irreversible tissue damage to the full atrial wall thickness, and short‐duration ablation reduces the conductive phase which may minimize damage to the surrounding tissue 15 . In previous studies, HPSD ablation has been demonstrated to be as effective as conventional power for PVI, notably with a higher rate of first‐round PVI, lower procedural and radiofrequency duration, and overall low procedural complication rate 1–5,16–19 . Besides PVI, HPSD has been recently described for posterior wall isolation 20 and cavotricuspid isthmus (CTI) ablation 21 …”

Section: Discussionmentioning

confidence: 99%

Ablation Index‐guided high‐power (50 W) short‐duration for left atrial anterior and roofline ablation: Feasibility, procedural data, and lesion analysis (AI High‐Power Linear Ablation)

Zanchi

Chen

Bordignon

et al. 2021

Self Cite

Objectives To evaluate the feasibility, procedural data, and lesion characteristics of the anterior line (AL) and roofline (RL) ablation by using ablation index (AI)‐guided high power (50 W) among patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after pulmonary vein isolation (PVI). Methods Data from 35 consecutive patients with macro‐reentrant left atrial tachycardia or substrate at the left atrium anterior wall or roof after previous PVI were collected. Ablation power was set to 50 W, targeting AI 500 for AL and 400 for RL. The first‐pass conduction block (FPB) was evaluated. The AL was arbitrarily divided into three (caudal, middle, and cranial) segments to analyze the location of conduction gaps in non‐FPB patients. Results A total of 32 AL and 17 RL were deployed and FPB was achieved in 24 (75%) and 14 (82%) of them, respectively. In the non‐FPB group, the most frequent gap location along the AL was the middle third. The final block of AL was achieved in 97%, and the block of RL was achieved in 100%. The radiofrequency (RF) ablation time was short (2.9 ± 0.8 min for AL and 46.2 ± 15.6 s for RL). For AL, the female gender was significantly more frequent in FPB than in non‐FPB patients (p = .028); patients with non‐FPB were associated with significantly longer RF time as compared to patients with FPB (204 ± 47 s vs. 161 ± 41 s; p = .02). No procedural complications occurred. Conclusion AI‐guided high‐power (50 W) ablation appears to be a feasible, effective, and fast technique for AL and RL ablation.

“…Nonetheless, if the use of standard temperature probes with thermocouples could have reduced the incidence of EDEL in this specific setting using 50 W ablation power and a relatively short ablation time in conjunction with a specialized ablation catheter, remains unanswered. Recently, Chen et al 17 published results of a prospective non‐randomized study comparing 60 patients undergoing 50 W high‐power short duration ablation with (cutoff luminal temperature > 39°C) and 60 patients without intraluminal esophageal temperature measurement resulting in a comparably low incidence of EDEL. Interestingly, in this study a target AI value of 400 at the posterior wall was chosen compared with a target AI of 350 in our study.…”

Section: Discussionmentioning

confidence: 99%

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

Piringer

Deneke

Foldyna

et al. 2021

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.