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 short-duration (AI-HP) pulmonary vein isolation (PVI) in terms of endoscopic esophageal lesions.

Background: The risk of esophageal injury during PVI is a major concern while ablating the posterior wall 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 wall/posterior wall: 550/400). All patients were under LET monitoring (cutoff LET 39°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°C was 47%, and the mean peak LET was 41.2 ± 1.8°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 Ω, and 419 ± 44.6.

Conclusions: AI-HP (50 W) ablation appears to be a highly efficient ablation technique for PVI. The incidence of esophageal injury during AI-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.