Incidence of ablation-induced esophageal lesions and gastroparesis in patients undergoing ablation index guided high power short duration atrial fibrillation ablation.
ablation index
atrial fibrillation
catheter ablation
endoscopically detected esophageal lesion
esophagogastroduodenoscopy
gastroparesis
high power short duration ablation
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
revised:
17
10
2022
received:
29
07
2022
accepted:
27
10
2022
pubmed:
3
11
2022
medline:
18
1
2023
entrez:
2
11
2022
Statut:
ppublish
Résumé
Aim of this study was to evaluate the incidence of ablation-induced endoscopically detected esophageal lesions (EDEL) and gastroparesis in patients undergoing high-power short-duration (HPSD) atrial fibrillation (AF) ablation using different target ablation index (AI) values. Consecutive patients undergoing AF ablation were included. Radiofrequency (RF) ablation was performed using HPSD ablation (50 W, target AI of 320 and 350 (group 1) and 380 (group 2) at posterior wall). Postablation endoscopy was performed in all patients. In total, 233 patients (66.8 ± 10 years; 52% male) were included consecutively (n = 137 patients in group 1 and n = 96 patients in group 2). Mean AI values und RF time at posterior wall was significantly higher and longer in group 2 compared to group 1 patients (413 ± 9 vs. 392 ± 19 AI, p < 0.01; 9.0 ± 0.8 s vs. 7.8 ± 0.7 s, p < 0.01). Esophageal endoscopy revealed esophageal lesions or gastroparesis in 43 of 233 patients (18.5%) in the total cohort (13.1% in group 1 and 26.0% in group 2; p = 0.02). Incidence of EDEL was 8.0% and 13.5% in group 1 and group 2, respectively. According to logistic analysis incidence of EDEL and/or gastroparesis was significantly lower in patients with a higher body mass index and higher in group 2 patients compared to group 1 patients. The incidence of EDEL or gastroparesis in patients undergoing HPSD AF ablation was 18.5% in the total cohort. The risk of EDEL and gastroparesis was associated with a higher AI target value of 380 compared to 320 and 350 at posterior wall and was reversely associated with body mass index.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
82-89Informations de copyright
© 2022 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.
Références
Reddy VY, Grimaldi M, De Potter T, et al. Pulmonary vein isolation with very high power, short duration, temperature-controlled lesions. JACC Clin Electrophysiol. 2019;5:778-786. doi:10.1016/j.jacep.2019.04.009.24;136:1588-1597
Winkle RA, Moskovitz R, Hardwin Mead R, et al. Atrial fibrillation ablation using very short duration 50 W ablations and contact force sensing catheters. J Interv Card Electrophysiol. 2018;52:1-8.
Kottmaier M, Popa M, Bourier F, et al. Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation. EP Europace. 2020;22:388-393. doi:10.1093/europace/euz342
Halbfass P, Wielandts JY, Knecht S, et al. Safety of very high-power short-duration radiofrequency ablation for pulmonary vein isolation: a two-centre report with emphasis on silent oesophageal injury. EP Europace. 2022;24:400-405. doi:10.1093/europace/euab261
Halbfass P, Pavlov B, Müller P, et al. Progression from esophageal thermal asymptomatic lesion to perforation complicating atrial fibrillation ablation: a single-center registry. Circ Arrhythm Electrophysiol. 2017. doi:10.1161/CIRCEP.117.005233
Yarlagadda B, Deneke T, Turagam M, et al. Temporal relationships between esophageal injury type and progression in patients undergoing atrial fibrillation catheter ablation. Heart Rhythm. 2019;16:204-212.
Halbfass P, Berkovitz A, Pavlov B, et al. Incidence of acute thermal esophageal injury after atrial fibrillation ablation guided by prespecified ablation index. J Cardiovasc Electrophysiol. 2019;30:2256-2261. doi:10.1111/jce.14193
Piringer R, Deneke T, Foldyna B, et al. 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. J Cardiovasc Electrophysiol. 2021;32:695-703. doi:10.1111/jce.14883
Phlips T, Taghji P, El Haddad M, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the ‘CLOSE’-protocol. EP Europace. 2018;20:f419-f427. doi:10.1093/europace/eux376
Keshishian J, Young J, Hill E, Saloum Y, Brady PG. Esophageal injury following radiofrequency ablation for atrial fibrillation: injury classification. Gastroenterol Hepatol (N Y). 2012;8:411-414.
Nielsen PB, Skjøth F, Overvad TF, Larsen TB, Lip GYH. Female sex is a risk modifier rather than a risk factor for stroke in atrial fibrillation: should we use a CHA2DS2-VA score rather than CHA2DS2-VASc? Circulation. 2018;137:832-840.
Chen S, Schmidt B, Seeger A, et al. Catheter ablation of atrial fibrillation using ablation index-guided highpower (50 W) for pulmonary vein isolation with or without esophageal temperature probe (the AI-HP ESO II). Heart Rhythm. 2020;17:1833-1840. doi:10.1016/j.hrthm.2020.05.029
Leshem E, Zilberman I, Tschabrunn CM, et al. High-Power and Short-Duration ablation for pulmonary vein isolation. JACC: Clin Electrophysiol. 2018;4:467-479.
Stauber A, Kornej J, Bollmann A, Hindricks G, Sommer P. Relevance of esophageal position and temperature on thermal injuries and rhythm outcome in atrial fibrillation ablations. Pacing Clin Electrophysiol. 2020;43:194-200.
Yamasaki H, Tada H, Sekiguchi Y, et al. Prevalence and characteristics of asymptomatic excessive transmural injury after radiofrequency catheter ablation of atrial fibrillation. Heart Rhythm. 2011;8:826-832.
Ha FJ, Han HC, Sanders P, et al. Prevalence and prevention of oesophageal injury during atrial fibrillation ablation: a systematic review and meta-analysis. EP Europace. 2019;21:80-90. doi:10.1093/europace/euy121
Schoene K, Arya A, Grashoff F, et al. Oesophageal probe evaluation in radiofrequency ablation of atrial fibrillation (OPERA): results from a prospective randomized trial. EP Europace. 2020;22:1487-1494. doi:10.1093/europace/euaa209