Korean Circ J.  2021 Feb;51(2):143-153. 10.4070/kcj.2020.0323.

Esophageal Thermal Injury after Catheter Ablation for Atrial Fibrillation with High-Power (50 Watts) Radiofrequency Energy

• Do U
• Kim J
• Kim M
• Cho MS
• Nam GB
• Choi KJ
• Kim YH

• KMID: 2512452
• DOI: http://doi.org/10.4070/kcj.2020.0323

Abstract

Background and Objectives
Data regarding the safety of atrial fibrillation (AF) ablation using high-power (50 W) radiofrequency (RF) energy in Asian populations are limited. This study was conducted to evaluate the incidence and pattern of esophageal injury after highpower AF ablation in an Asian cohort.
Methods
We searched the prospective AF ablation registry to identify patients who underwent AF ablation with 50 W RF energy using the smart touch surround flow catheter (Biosense Webster, Diamond Bar, CA, USA). Visitag™ (Biosense Webster) was used for lesion annotation with predefined settings of catheter stability (3 mm for 5 seconds) and minimum contact force (50% of time >5 g). All patients underwent upper gastrointestinal endoscopy at 1 or 3 days after the ablation.
Results
A total of 159 patients (mean age: 63±9 years, male: 69%, paroxysmal AF: 45.3%, persistent AF: 27.7%, long-standing persistent AF: 27.0%) were analyzed. Initially, 26 patients underwent pulmonary vein isolation with 50 W for 5 seconds at each point. The remaining 133 patients underwent prolonged RF duration (anterior 10 seconds and posterior 6 seconds). The incidence rates of esophageal erythema/erosion and superficial ulceration were 1.3% for each type of the lesion. Food stasis, a suggestive finding of gastroparesis, was observed in 25 (15.7%) patients. There were no cases of cardiac tamponade, stroke, or death.
Conclusions
In Asian patients, AF ablations using 50 W resulted in very low rates of mild esophageal complications.

Keyword

Atrial fibrillation; Complications; Endoscopy; Esophagus; Radiofrequency catheter ablation

Figure

• 

  Figure 1 Study flow diagram for inclusion and exclusion.AF = atrial fibrillation; HPSD = high-power, short-duration.

• 

  Figure 2 Representative examples of HPSD ablation. (A) shows an example of a patient who underwent PVI using the initial 5-second protocol. Automated lesion tagging with VisiTag (size of 3) was used. (B) shows an example of a patient who underwent PVI using the 6–10 seconds protocol. RF energy was delivered with 50 W for 10 seconds in the anterior and superior wall and 6 seconds in the posterior wall. A tag size of 2 was used, and further ablation was delivered to close the visual gap.HPSD = high-power, short-duration; PVI = pulmonary vein isolation; RF = radiofrequency.

• 

  Figure 3 MR images, computed tomographic images, and endoscopic findings of patients with esophageal complications. (A, B) show the MR images of LA, LIPV, and adjacent esophagus (marked with an asterisk) of patients with an esophageal ulcer. (C, D) show the endoscopic findings of superficial esophageal ulcers located at 27 cm and 34 cm from the upper incisor, respectively. (E, F) show the CT images of the esophagus (marked with an asterisk) adjacent to LIPV and posterior wall of LA in patients with esophageal erosion. (G, H) are endoscopic findings of esophageal erosions.CT = computed tomography; LA = left atrium; LIPV = left inferior pulmonary vein; MR = magnetic resonance.

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