Oesophageal safety in voltage-guided atrial fibrillation ablation using ablation index or contact force only: a prospective comparison.

Autor:	Schade A; Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany., Costello-Boerrigter L; Department of Cardiology and Center for Clinical Studies, Central Clinic Bad Berka, Robert-Koch-Alle 9, 99438 Bad Berka, Germany., Deneke T; Department of Cardiology II/Interventional Electrophysiology, Rhoen-Klinikum Campus Bad Neustadt, Von-Guttenberg Str. 11, 97616 Bad Neustadt, Germany., Steinborn F; Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany., Chapran M; Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany., Vathie K; Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany., Milisavljevic N; Department of Internal Medicine 2, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany., Franz M; Department of Internal Medicine I/Cardiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany., Surber R; Department of Internal Medicine I/Cardiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany., Assani M; Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany., Hamo H; Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany., Khshfeh M; Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany., Lauten A; Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany., Mattea V; Department of Cardiology/Interventional Electrophysiology, Helios Hospital Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2022 Dec 09; Vol. 24 (12), pp. 1909-1916.
DOI:	10.1093/europace/euac103
Abstrakt:	Aims: Left atrial ablation using radiofrequency (RF) is associated with endoscopically detected thermal oesophageal lesions (EDELs). The aim of this study was to compare EDEL occurrence after conventional contact force-guided (CFG) RF ablation vs. an ablation index-guided (AIG) approach in clinical routine of voltage-guided ablation (VGA). Predictors of EDEL were also assessed. Methods and Results: This study compared CFG (n = 100) with AIG (n = 100) in consecutive atrial fibrillation ablation procedures, in which both pulmonary vein isolation and VGA were performed. In the AIG group, AI targets were ≥500 anteriorly and ≥350-400 posteriorly. Upper endoscopy was performed after ablation.The CFG and AIG groups had comparable baseline characteristics. The EDEL occurred in 6 and 5% (P = 0.86) in the CFG and AIG groups, respectively. Category 2 lesions occurred in 4 and 2% (P = 0.68), respectively. All EDEL healed under proton pump inhibitor therapy. The AI > 520 was the only predictor of EDEL [odds ratio (OR) 3.84; P = 0.039]. The more extensive Category 2 lesions were predicted by: AI max > 520 during posterior ablation (OR 7.05; P = 0.042), application of posterior or roof lines (OR 5.19; P = 0.039), existence of cardiomyopathy (OR 4.93; P = 0.047), and CHA2DS2-VASc score (OR 1.71; P = 0.044). The only Category 2 lesion with AI max < 520 (467) occurred in a patient with low body mass index. Conclusions: Both methods were comparable with respect to clinical complications and EDEL. In consideration of previous reconnection data and our study results regarding oesophageal safety, optimal AI target range might be between 400 and 450. Competing Interests: Conflict of interest: A.S. reports to receive consultant fee by Johnson & Johnson. All remaining authors have declared no conflicts of interest. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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