Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry

Introduction Pulmonary vein isolation (PVI) using high‐power‐short‐duration (HPSD) radiofrequency ablation (RF) is emerging as the standard of care for treatment of atrial fibrillation (AF). While procedural short‐term to midterm efficacy and efficiency are very promising, this registry aims to inve...

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Published in:Journal of cardiovascular electrophysiology 2022-11, Vol.33 (11), p.2276-2284
Main Authors: Francke, Alexander, Naumann, Gregor, Weidauer, Marie‐Christin, Scharfe, Frank, Schoen, Steffen, Wunderlich, Carsten, Christoph, Marian
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Language:English
Subjects:
ablation index
atrial fibrillation
CLOSE protocol
endoscopically detected esophageal lesion (EDEL)
high‐power‐short‐duration (HPSD)
pulmonary vein isolation (PVI)
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container_issue 11
container_start_page 2276
container_title Journal of cardiovascular electrophysiology
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creator Francke, Alexander
Naumann, Gregor
Weidauer, Marie‐Christin
Scharfe, Frank
Schoen, Steffen
Wunderlich, Carsten
Christoph, Marian
description Introduction Pulmonary vein isolation (PVI) using high‐power‐short‐duration (HPSD) radiofrequency ablation (RF) is emerging as the standard of care for treatment of atrial fibrillation (AF). While procedural short‐term to midterm efficacy and efficiency are very promising, this registry aims to investigate esopahgeal safety using an optimized ablation approach. Methods In a single‐center experience, 388 consecutive standardized first‐time AF ablation were performed using a CLOSE‐guided‐fixed‐50 W‐circumferential PVI and substrate modification without intraprocedural esophageal temperature measurement. Three hundred patients underwent postprocedural esophageal endoscopy to diagnose and grade endoscopically detected esophageal lesions (EDEL) and were included in the analysis. Results EDEL were detected in 35 of 300 patients (11.6%), 25 of 35 were low‐grade Kansas‐city‐classification (KCC) 1 lesions with fast healing tendencies. Six patients suffered KCC 2a lesions, 4 patients had KCC 2b lesions (1.3% of all patients). No esophageal perforation or fistula formation was observed. Patient baseline characteristics, especially patients age, gender, and body mass index did not influence EDEL incidence. Additional posterior box isolation did not increase the incidence of EDEL. In patients diagnosed with EDEL, mean catheter contact force during posterior wall ablation was higher (11.9 ± 1.8 vs. 14.7 ± 3 g, p 
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While procedural short‐term to midterm efficacy and efficiency are very promising, this registry aims to investigate esopahgeal safety using an optimized ablation approach. Methods In a single‐center experience, 388 consecutive standardized first‐time AF ablation were performed using a CLOSE‐guided‐fixed‐50 W‐circumferential PVI and substrate modification without intraprocedural esophageal temperature measurement. Three hundred patients underwent postprocedural esophageal endoscopy to diagnose and grade endoscopically detected esophageal lesions (EDEL) and were included in the analysis. Results EDEL were detected in 35 of 300 patients (11.6%), 25 of 35 were low‐grade Kansas‐city‐classification (KCC) 1 lesions with fast healing tendencies. Six patients suffered KCC 2a lesions, 4 patients had KCC 2b lesions (1.3% of all patients). No esophageal perforation or fistula formation was observed. Patient baseline characteristics, especially patients age, gender, and body mass index did not influence EDEL incidence. Additional posterior box isolation did not increase the incidence of EDEL. In patients diagnosed with EDEL, mean catheter contact force during posterior wall ablation was higher (11.9 ± 1.8 vs. 14.7 ± 3 g, p &lt; .001), mean RF duration was shorter (11.9 ± 1 vs. 10.7 ± 1.2 s, p &lt; .001), while achieved ablation index was not different between groups (434 ± 4.9 vs. 433 ± 9.5, n.s.). Conclusion Incidence of EDEL after CLOSE‐guided‐50 W‐HPSD PVI is lower compared to historical cohorts using standard‐power RF settings. Catheter contact force during posterior HPSD ablation should not exceed 15 g.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.15656</identifier><language>eng</language><subject>ablation index ; atrial fibrillation ; CLOSE protocol ; endoscopically detected esophageal lesion (EDEL) ; high‐power‐short‐duration (HPSD) ; pulmonary vein isolation (PVI)</subject><ispartof>Journal of cardiovascular electrophysiology, 2022-11, Vol.33 (11), p.2276-2284</ispartof><rights>2022 The Authors. published by Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2676-65338f0ed5e2ac9a30ddb7885369b149f00288bfe7935eb24669b372c258d2073</citedby><cites>FETCH-LOGICAL-c2676-65338f0ed5e2ac9a30ddb7885369b149f00288bfe7935eb24669b372c258d2073</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids></links><search><creatorcontrib>Francke, Alexander</creatorcontrib><creatorcontrib>Naumann, Gregor</creatorcontrib><creatorcontrib>Weidauer, Marie‐Christin</creatorcontrib><creatorcontrib>Scharfe, Frank</creatorcontrib><creatorcontrib>Schoen, Steffen</creatorcontrib><creatorcontrib>Wunderlich, Carsten</creatorcontrib><creatorcontrib>Christoph, Marian</creatorcontrib><title>Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry</title><title>Journal of cardiovascular electrophysiology</title><description>Introduction Pulmonary vein isolation (PVI) using high‐power‐short‐duration (HPSD) radiofrequency ablation (RF) is emerging as the standard of care for treatment of atrial fibrillation (AF). While procedural short‐term to midterm efficacy and efficiency are very promising, this registry aims to investigate esopahgeal safety using an optimized ablation approach. Methods In a single‐center experience, 388 consecutive standardized first‐time AF ablation were performed using a CLOSE‐guided‐fixed‐50 W‐circumferential PVI and substrate modification without intraprocedural esophageal temperature measurement. Three hundred patients underwent postprocedural esophageal endoscopy to diagnose and grade endoscopically detected esophageal lesions (EDEL) and were included in the analysis. Results EDEL were detected in 35 of 300 patients (11.6%), 25 of 35 were low‐grade Kansas‐city‐classification (KCC) 1 lesions with fast healing tendencies. Six patients suffered KCC 2a lesions, 4 patients had KCC 2b lesions (1.3% of all patients). No esophageal perforation or fistula formation was observed. Patient baseline characteristics, especially patients age, gender, and body mass index did not influence EDEL incidence. Additional posterior box isolation did not increase the incidence of EDEL. In patients diagnosed with EDEL, mean catheter contact force during posterior wall ablation was higher (11.9 ± 1.8 vs. 14.7 ± 3 g, p &lt; .001), mean RF duration was shorter (11.9 ± 1 vs. 10.7 ± 1.2 s, p &lt; .001), while achieved ablation index was not different between groups (434 ± 4.9 vs. 433 ± 9.5, n.s.). Conclusion Incidence of EDEL after CLOSE‐guided‐50 W‐HPSD PVI is lower compared to historical cohorts using standard‐power RF settings. Catheter contact force during posterior HPSD ablation should not exceed 15 g.</description><subject>ablation index</subject><subject>atrial fibrillation</subject><subject>CLOSE protocol</subject><subject>endoscopically detected esophageal lesion (EDEL)</subject><subject>high‐power‐short‐duration (HPSD)</subject><subject>pulmonary vein isolation (PVI)</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp1kMFOwkAQhhujiYgefIMe9VDY7na3W2-EVMGQQBT12CztlC4pbN1tJdyIN28-gs_io_AkruDVOcw_mflmkvkd59JHHd9Gd5FCx6eMsiOn5dMAedxn4bGtUUA9wkNy6pwZs0DIJwzRlvMeG1UVYg6idI3Iod64cuX2R-PHeLf9nDcyg8ylaLf9eHELOS9ss1Jr0FZNoXRtNWu0qKVauVVTLtVK6I37BvaINKrcD26-v6YFuJOHeBD3pnZj8jy0WcNcmlpvzp2TXJQGLv607TzdxtP-wBuN74b93shLMQuZxyghPEeQUcAijQRBWTYLOaeERTM_iHKEMOezHMKIUJjhgNk-CXGKKc8wCknbuTrcrbR6bcDUyVKaFMpSrEA1JsEhIhEPAoYten1AU62M0ZAnlZZL-1nio-TX58T6nOx9tmz3wK5lCZv_weS-Hx82fgDepoZ4</recordid><startdate>202211</startdate><enddate>202211</enddate><creator>Francke, Alexander</creator><creator>Naumann, Gregor</creator><creator>Weidauer, Marie‐Christin</creator><creator>Scharfe, Frank</creator><creator>Schoen, Steffen</creator><creator>Wunderlich, Carsten</creator><creator>Christoph, Marian</creator><scope>24P</scope><scope>WIN</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202211</creationdate><title>Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry</title><author>Francke, Alexander ; Naumann, Gregor ; Weidauer, Marie‐Christin ; Scharfe, Frank ; Schoen, Steffen ; Wunderlich, Carsten ; Christoph, Marian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2676-65338f0ed5e2ac9a30ddb7885369b149f00288bfe7935eb24669b372c258d2073</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>ablation index</topic><topic>atrial fibrillation</topic><topic>CLOSE protocol</topic><topic>endoscopically detected esophageal lesion (EDEL)</topic><topic>high‐power‐short‐duration (HPSD)</topic><topic>pulmonary vein isolation (PVI)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Francke, Alexander</creatorcontrib><creatorcontrib>Naumann, Gregor</creatorcontrib><creatorcontrib>Weidauer, Marie‐Christin</creatorcontrib><creatorcontrib>Scharfe, Frank</creatorcontrib><creatorcontrib>Schoen, Steffen</creatorcontrib><creatorcontrib>Wunderlich, Carsten</creatorcontrib><creatorcontrib>Christoph, Marian</creatorcontrib><collection>Wiley Open Access Journals</collection><collection>Wiley Online Library Open Access</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Francke, Alexander</au><au>Naumann, Gregor</au><au>Weidauer, Marie‐Christin</au><au>Scharfe, Frank</au><au>Schoen, Steffen</au><au>Wunderlich, Carsten</au><au>Christoph, Marian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><date>2022-11</date><risdate>2022</risdate><volume>33</volume><issue>11</issue><spage>2276</spage><epage>2284</epage><pages>2276-2284</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Introduction Pulmonary vein isolation (PVI) using high‐power‐short‐duration (HPSD) radiofrequency ablation (RF) is emerging as the standard of care for treatment of atrial fibrillation (AF). While procedural short‐term to midterm efficacy and efficiency are very promising, this registry aims to investigate esopahgeal safety using an optimized ablation approach. Methods In a single‐center experience, 388 consecutive standardized first‐time AF ablation were performed using a CLOSE‐guided‐fixed‐50 W‐circumferential PVI and substrate modification without intraprocedural esophageal temperature measurement. Three hundred patients underwent postprocedural esophageal endoscopy to diagnose and grade endoscopically detected esophageal lesions (EDEL) and were included in the analysis. Results EDEL were detected in 35 of 300 patients (11.6%), 25 of 35 were low‐grade Kansas‐city‐classification (KCC) 1 lesions with fast healing tendencies. Six patients suffered KCC 2a lesions, 4 patients had KCC 2b lesions (1.3% of all patients). No esophageal perforation or fistula formation was observed. Patient baseline characteristics, especially patients age, gender, and body mass index did not influence EDEL incidence. Additional posterior box isolation did not increase the incidence of EDEL. In patients diagnosed with EDEL, mean catheter contact force during posterior wall ablation was higher (11.9 ± 1.8 vs. 14.7 ± 3 g, p &lt; .001), mean RF duration was shorter (11.9 ± 1 vs. 10.7 ± 1.2 s, p &lt; .001), while achieved ablation index was not different between groups (434 ± 4.9 vs. 433 ± 9.5, n.s.). Conclusion Incidence of EDEL after CLOSE‐guided‐50 W‐HPSD PVI is lower compared to historical cohorts using standard‐power RF settings. Catheter contact force during posterior HPSD ablation should not exceed 15 g.</abstract><doi>10.1111/jce.15656</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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source Wiley-Blackwell Read & Publish Collection
subjects ablation index
atrial fibrillation
CLOSE protocol
endoscopically detected esophageal lesion (EDEL)
high‐power‐short‐duration (HPSD)
pulmonary vein isolation (PVI)
title Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry
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