Outcomes of Exclusive 50 W High Power, 5 s Ablation Close to the Esophagus in Pulmonary Vein Isolation.

Abstract

Background: In pulmonary vein isolation (PVI) employing a high-power and short-duration (HP-SD) strategy, no consensus exists regarding the optimal settings for radiofrequency application (RFA) to the section of left atrium adjacent to the esophagus (esophageal area, EA).

Objective: To evaluate (1) the efficacy and safety of HP-SD RFA with 50 W for 5 s on the EA, and (2) the predictive factors of esophageal thermal injury (ETI).

Methods: We performed esophagogastroduodenoscopy on 85 patients who had undergone PVI with 50 W RFA. RFA duration was limited to 5 s on the EA.

Results: Of the 85 patients, 16 (18.8%) developed asymptomatic thermal injury (1 mucosal injury, namely erosion and 15 gastric hypomotility). All of those were asymptomatic and transient, and any symptomatic or severe, esophageal or gastric complications was not observed. On the EA, conduction block was achieved after the first encircling in 82 (96.5%) patients. The number of RFA on the EA and the proportion of patients whose EA was located at the posterior wall of the right inferior PV (right-sided EA) were higher in the patients with ETI than without (9.0 [7.0-10.5] vs. 7.0 [5.0-9.0] p = 0.021, and 18.8% vs. 2.9%, p = 0.044, respectively). In multivariate analysis, the number of RFA on the EA (hazard ratio 1.32, p = 0.019) and RFA on the right-sided EA (hazard ratio, 13.50, p = 0.013) were identified as the predictors of ETI.

Conclusion: RFA of 50 W for 5 s on the EA can be performed with a low incidence of esophageal mucosal injury while maintaining efficacy. RFA on the right-sided EA and the high number of RFA on the EA increase the risk of ETI.