Background: The risk of esophageal injury during pulmonary vein isolation (PVI) is one major concern while ablating the posterior-wall for patients with atrial fibrillation. Luminal esophageal temperature (LET) rise during ablation is one surrogate of esophageal lesion development.
Objective: To investigate the safety profile of a novel ablation index guided high power short duration (AI-HP) PVI in terms of endoscopic esophageal lesion.
Methods: 122 consecutive symptomatic AF patients underwent AI-HP PVI (50 W throughout the ablation, AI anterior-wall/posterior-wall: 550/400). All patients were under LET monitoring (cut-off LET: 39℃) during the ablation procedure and all patients with LET rise received esophageal endoscopy examination 1-3 days after the ablation. Ablation lesion data of the sites with LET rise were analyzed.
Results: Procedural PVI success rate was 100%. Per procedure the mean radiofrequency ablation time, procedural time, and fluoroscopic time were: 12±2min, 57±7min, 6±2min. The incidence of LET rise was 47.5%, mean increased LET was 41.2±1.8℃ (max. 45℃). The rate of endoscopic detected erythema/erosion was 2/121(1.7%). No ulceration and perforation was found. The mean contact force, application duration, impedance drop and AI at the sites with LET rise were: 22.1±8.9g, 7±2.4s, 9.4±4.6Ω, 419±44.6.
Conclusion: The incidence of esophageal injury during AI-HP PVI seems markedly low. AI-HP ablation for the left atrial posterior-wall appears safe and efficient.