Acute oesophageal safety and long-term follow-up of AI-guided high-power short-duration with 50 W for atrial fibrillation ablation

Müller, J; Nentwich, K; Berkovitz, A; Ene, E; Sonne, K; Zhuravlev, V; Chakarov, I; Barth, S; Waechter, C; Behnes, M; Halbfass, P; Deneke, T

doi:10.1093/europace/euad053

Arrhythmias & electrophysiology

Acute oesophageal safety and long-term follow-up of ablation index (AI)-guided high-power short-duration with 50 W for atrial fibrillation ablation

EuropacePublished 7 Mar 2023Retrospective cohort study

Main finding · Endoscopically detected thermal oesophageal lesions (EDEL)ResultOdds ratio 4.799 CI 1.427–16.138

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Authors' conclusion

High-power short-duration AF ablation with target AI of 400 for non-posterior wall and 300 for posterior wall lesions resulted in comparable long-term results compared to higher AI (450/350) ablations with significantly lower risk for thermal oesophageal lesions.

Study context

Population: Patients undergoing first atrial fibrillation (AF) ablation with AI-guided HPSD (50 W) using ThermoCool SmartTouch SF catheter
Participants: 795 patients

Exposure: AI 400/300 vs AI 450/350 HPSD AF ablation
AI 400/300n = 211
AI 450/350n = 584reference
Outcome: Endoscopically detected thermal oesophageal lesions (EDEL)

Methodological detailsconsecutive patients

Consecutive patients

Main finding

As reported in the abstract

Odds ratio

4.799

CI 1.427–16.138

P = 0.011

By group

AI 400/3003%

AI 450/3507%

AI 450/350

OR 4.799 (CI 1.427–16.138); P = 0.011

Observational data: associations, not effects.

Further findings

Single-procedure success, AI 400/300 vs AI 450/350 · 12 months; long-term after mean 25 ± 7 months

12-month success comparable between target AI groups: 76% vs. 76%: P = 0.892
Long-term success comparable between target AI groups: 68% vs. 71%: log-rank P = 0.452

Single-procedure success, paroxysmal vs persistent AF (subgroup) · 12 months; end of follow-up

12 months: paroxysmal vs persistent AF 80% vs. 72%: P = 0.010
End of follow-up: paroxysmal vs persistent AF 76% vs. 65%: log-rank P = 0.001

Redo procedures and pulmonary vein (PV) reconnection · during follow-up

Patients undergoing redo procedure: 103 (16%)
Comparable PV reconnection among groups

Multivariate predictors of AF recurrence

Age, left atrium (LA) size, persistent AF and extra-PV ablation targets

Original publication

Acute oesophageal safety and long-term follow-up of AI-guided high-power short-duration with 50 W for atrial fibrillation ablation. Europace. Published 7 March 2023. doi:10.1093/europace/euad053

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