High-Power Short-Duration Atrial Fibrillation Ablation: Strategy to Reduce Luminal Esophageal Temperature With Contact Force Catheters

Abstract

Background: Atrial fibrillation (AF) ablation is an alternative treatment to medical therapy. One of most feared complications is atrioesophageal fistula. Methods: Retrospective analysis of 355 consecutive patients undergoing first AF ablation. Low-power long-duration (LPLD) group contained 158 patients, 121 (76.58%) having paroxysmal AF underwent ablation with power 20/30W (anterior and posterior left atrial wall), 17 mL/min flow, and contact force of 10-30g/30 s. High-power short-duration group (HPSD) contained 197 patients, 113 (57.36%) paroxysmal AF underwent ablation at 45/50W power, contact force of 8-15g/10-20g and a 35 mL/min flow rate for 6-8 s on the anterior and the posterior left atrial wall, respectively. Both groups had pulmonary veins isolated and atrial flutter ablated when needed. Patients not in sinus rhythm, cardioversion was performed before ablation. Results: There were no complications. LPLD group: Left atrial time 118.74 min, total 145.32 min, radiofrequency time 4,317.99 s, X-ray 13.42 min, and elevation of luminal esophageal temperature (LET) in 132 (84.53%) patients. HPSD group: Left atrial time 72.16 min, total 93.76 min, radiofrequency time 1,511.29 s, X-ray 7.6 min, and LET elevation in only 75 (38.07%) patients. In Group A, 10 patients were submitted to endoscopy, and 1 (10%) had mild erythema. In Group B, 13 performed the endoscopy, with 2 (15.38%) patients showing mild erythema. Conclusions: The high-power short-duration technique, compared to the low-power long-duration technique, is a safe, useful, and efficient approach for reducing the LET elevation and esophageal injury because of the very significant reduction in the heating rate of this organ.