Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial).

Autor:	Chieng D; Clinical Electrophysiology Research, Baker Heart and Diabetes Research Institute, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.; Department of Cardiology, Cabrini Hospital, 181/183 Wattletree Road, Malvern, Victoria 3144, Australia., Segan L; Clinical Electrophysiology Research, Baker Heart and Diabetes Research Institute, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.; Department of Cardiology, Cabrini Hospital, 181/183 Wattletree Road, Malvern, Victoria 3144, Australia., Sugumar H; Clinical Electrophysiology Research, Baker Heart and Diabetes Research Institute, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.; Department of Cardiology, Cabrini Hospital, 181/183 Wattletree Road, Malvern, Victoria 3144, Australia., Al-Kaisey A; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.; Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia., Hawson J; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.; Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia., Moore BM; Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia., Nam MCY; Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia., Voskoboinik A; Clinical Electrophysiology Research, Baker Heart and Diabetes Research Institute, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.; Department of Cardiology, Cabrini Hospital, 181/183 Wattletree Road, Malvern, Victoria 3144, Australia., Prabhu S; Clinical Electrophysiology Research, Baker Heart and Diabetes Research Institute, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia., Ling LH; Clinical Electrophysiology Research, Baker Heart and Diabetes Research Institute, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.; Department of Cardiology, Cabrini Hospital, 181/183 Wattletree Road, Malvern, Victoria 3144, Australia., Ng JF; Department of Gastroenterology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia., Brown G; Department of Gastroenterology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia., Lee G; Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia., Morton J; Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia., Debinski H; Department of Cardiology, Cabrini Hospital, 181/183 Wattletree Road, Malvern, Victoria 3144, Australia., Kalman JM; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.; Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3050, Australia.; School of Medicine, Monash University, Wellington Road, Clayton, Victoria 3800, Australia., Kistler PM; Clinical Electrophysiology Research, Baker Heart and Diabetes Research Institute, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; Department of Cardiology, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.; School of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.; Department of Cardiology, Cabrini Hospital, 181/183 Wattletree Road, Malvern, Victoria 3144, Australia.; School of Medicine, Monash University, Wellington Road, Clayton, Victoria 3800, Australia.
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] 2023 Feb 16; Vol. 25 (2), pp. 417-424.
DOI:	10.1093/europace/euac190
Abstrakt:	Aims: Radiofrequency (RF) ablation for pulmonary vein isolation (PVI) in atrial fibrillation (AF) is associated with the risk of oesophageal thermal injury (ETI). Higher power short duration (HPSD) ablation results in preferential local resistive heating over distal conductive heating. Although HPSD has become increasingly common, no randomized study has compared ETI risk with conventional lower power longer duration (LPLD) ablation. This study aims to compare HPSD vs. LPLD ablation on ETI risk. Methods and Results: Eighty-eight patients were randomized 1:1 to HPSD or LPLD posterior wall (PW) ablation. Posterior wall ablation was 40 W (HPSD group) or 25 W (LPLD group), with target AI (ablation index) 400/LSI (lesion size index) 4. Anterior wall ablation was 40-50 W, with a target AI 500-550/LSI 5-5.5. Endoscopy was performed on Day 1. The primary endpoint was ETI incidence. The mean age was 61 ± 9 years (31% females). The incidence of ETI (superficial ulcers n = 4) was 4.5%, with equal occurrence in HPSD and LPLD (P = 1.0). There was no difference in the median value of maximal oesophageal temperature (HPSD 38.6°C vs. LPLD 38.7°C, P = 0.43), or the median number of lesions per patient with temperature rise above 39°C (HPSD 1.5 vs. LPLD 2, P = 0.93). Radiofrequency ablation time (23.8 vs. 29.7 min, P < 0.01), PVI duration (46.5 vs. 59 min, P = 0.01), and procedure duration (133 vs. 150 min, P = 0.05) were reduced in HPSD. After a median follow-up of 12 months, AF recurrence was lower in HPSD (15.9% vs. LPLD 34.1%; hazard ratio 0.42, log-rank P = 0.04). Conclusion: Higher power short duration ablation was associated with similarly low rates of ETI and shorter total/PVI RF ablation times when compared with LPLD ablation. Higher power short duration ablation is a safe and efficacious approach to PVI. Competing Interests: Conflict of interest: D.C. is supported by co-funded NHMRC/NHF post-graduate scholarship. The following industry funding sources regarding activities outside the submitted work have been declared in accordance with ICMJE guidelines. P.M.K. has received funding from Abbott Medical for consultancy and speaking engagements and fellowship support from Biosense Webster. J.M.K. holds a Practitioner Fellowship of the NHMRC and has research and fellowship support from Medtronic, Abbott and Biosense Webster. S.P. has a NHMRC Post Doctoral Research Fellowship. A.V. has a National Heart Foundation Early Career Fellowship. The remaining authors have nothing to disclose. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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