Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-133 - Safety And Effectiveness Of Pulmonary Vein Isolation Using High Power-short Duration Strategy For Atrial Fibrillation: Result Of Endoscopic Examination (ID 221)


Background: Little consensus exists regarding the optimal power and duration settings of the radiofrequency ablation on the esophageal area when using the high power-short duration (HPSD) strategy.
Objective: The purpose of this study was to evaluate the impact of the HPSD strategy on the esophageal area.
Methods: Fifty-nine consecutive patients (68±9 years, 45 males) undergoing index pulmonary vein isolation (PVI) followed by the endoscopy performed within 5 days after the procedure were studied. Fluoroscopic image of esophagography was registered on the CARTO3 system using the CARTOUNIVU module to precisely determine the ablation sites, and radiofrequency applications were limited to the fixed 50-W/5-second setting at the esophageal area without any use of esophageal temperature monitoring. Extensive PVI including esophageal area was performed by the 50-W radiofrequency applications, with the targeted interlesion distance of ≤6 mm, ablation index (AI) of 400 for the posterior wall, and contact force (CF) of 5-15g using Thermocool SmartTouch SF catheter.
Results: Endoscopy was performed 2±1 days after the procedure. At the posterior wall, radiofrequency application time was 10.95±3.30 seconds, CF 10.05±3.71g, and AI 397.30±30.03 per lesion. In the esophageal area, a median number of radiofrequency applications was 7 per patient, application time was 5.19±1.22 seconds, CF 9.17±3.24g, and AI 304.90±32.59 per lesion. None of the patients developed any esophageal erythema, erosion or ulceration. After the first encircling, the conduction gap on the esophageal area was observed in 3% (2 of 59) of the patients.
Conclusion: PVI using HPSD strategy with exclusive 50-W/5-second applications on the esophagus could be safely performed without any esophageal injury while maintaining the durability of lesion.