Po-01-038 the prevalence and characteristics of the esophageal thermal injury in extensive pulmonary vein isolation using high power-short duration ablation strategy

There is little knowledge regarding the impact of radiofrequency (RF) ablation on the esophageal area when using the high power-short duration (HPSD) strategy. The purpose of this study was to evaluate the prevalence and the characteristics of the esophageal thermal injury in extensive pulmonary vein isolation (extensive-PVI) using HPSD strategy. Eighty-five consecutive patients (age:67±9 year, male:63) undergoing index extensive-PVI followed by the esophagogastroscopy performed within 5 days after the procedure were studied. Fluoroscopic image of esophagography was registered on the CARTO3 system (Biosense Webster, Inc., CA, USA) using the CARTOUNIVU (Biosense Webster, Inc.) module to precisely determine the ablation sites, and RF applications were limited to the fixed 50W/5-second setting at the esophageal area without any use of esophageal temperature monitoring. Extensive-PVI including esophageal area was performed by the 50W RF applications, with the targeted interlesion distance of ≤6 mm, ablation index (AI) of 400 for the posterior wall, and contact force (CF) of 5-15g using Thermocool SmartTouch Surround Flow catheter (Biosense Webster, Inc). Esophagogastroscopy was performed 2±1 days after the procedure. In the esophageal area, a median number of RF applications was 8 per patient, application time was 5.1±1.2 seconds, CF was 8.9±2.8g, and AI was 300.9±28.0 per lesion. After the first encircling, additional RF application was required for the conduction gap on the esophageal area in 4.7% (4 of 85) of the patients. Sixteen patients (18.8%) developed esophageal thermal injury (esophageal erosion: 1 patient, gastric hypomotility: 15 patients). All patients with esophageal thermal injury were asymptomatic. Multivariate logistic regression analysis revealed that RF applications to the esophageal area positioned at the posterior wall of right pulmonary veins because of the central or right esophageal location was the independent predictor of the esophageal thermal injury (odds ratio: 7.92, 95% confidence interval: 1.15 to 54.49, p=0.035). Although asymptomatic esophageal thermal injury were not rare, extensive-PVI using HPSD with exclusive 50W/5-second applications on the esophagus could be performed with low risk of the esophageal mucosal injury while maintaining the durability of lesion. More careful RF applications may be required for the esophageal area positioned at the posterior wall of right pulmonary veins.