Esophageal Endoscopy After Catheter Ablation of Atrial Fibrillation Using Ablation-Index Guided High-Power Frankfurt AI-HP ESO-I

OBJECTIVES This study sought to investigate the safety profile of a novel ablation index-guided high-power shortduration (AI-HP) pulmonary vein isolation (PVI) in terms of endoscopic esophageal lesions. BACKGROUND The risk of esophageal injury during PVI is a major concern white ablating the posterior watt for patients with atrial fibrillation. Luminal esophageal temperature (LET) rise during ablation is a surrogate for esophageal lesion development. METHODS A total of 122 consecutive symptomatic atrial fibrillation patients underwent AI-HP PVI (50 W throughout the ablation, AI anterior watt/posterior wall: 550/400). All patients were under LET monitoring (cutoff LET 39 degrees C) during the ablation procedure, and patients with LET rise received esophageal endoscopy examination 1 to 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 11.9 +/- 2.7 min, 54.8 +/- 9 min, and 5.5 +/- 1.6 min. The incidence of LET >39 degrees C was 47%, and the mean peak LET was 41.2 +/- 1.8 degrees C. The rate of endoscopic detected lesion was 2 of 57 (3.5%). No perforation or atrial-esophageal fistula was found. The mean contact force, application duration, impedance drop, and AI values at the sites with LET rise were 22.1 +/- 8.9 g, 7 +/- 2.4 s, 9.4 +/- 4.6 Omega, and 419 +/- 44.6. CONCLUSIONS Al-HP (50 W) ablation appears to be a highly efficient ablation technique for PVI. The incidence of esophageal injury during Al-HP PVI seems markedly low. AI-HP ablation targeting AI 400 in combination with multisensor esophageal temperature monitoring for the left atrial posterior wall appears safe and efficient. (C) 2020 by the American College of Cardiology Foundation.