Co-Author(s):
Amir Naqvi, DO
Evan Hiner, MD
Dipak Shah, MD
Ascension Providence Hospital/MSU-CHM
16001 W. 9 Mile Road 4th Flr Fisher Building Southfield, MI 48075
Introduction | Objectives: Atrial fibrillation (AF) ablation, while generally safe, can result in
esophageal injury. Esophageal temperature monitoring is routinely used
to guide radiofrequency ablation (RFA). High power short duration
(HPSD) RFA is becoming more utilized. Traditional RFA relies on distal
conductive heating while HPSD creates lesions by local conductive and
resistive heating; thereby, potentially minimizing esophageal
injury. The objective of this study is to compare traditional versus
HPSD RFA on esophageal temperature during AF ablation.
Methods: We conducted a retrospective analysis of all consecutive AF ablations
performed over an 18-month period. All ablations were performed by one
operator who changed his practice from traditional to HPSD RFA. The
parameters of the traditional ablation were 15-30 grams of contact
force, force time integral (FTI) of 400-600, and power of 20–30 Watts.
The parameters for HPSD were contact force of 5-20 grams with 50 Watts
of power applied for 3-15 seconds targeting a 10Ω impedance drop. Data
analysis included type of method used, temperature changes and basic
characteristics including underlying type of AF. Patients were excluded
if they had prior left atrial ablation. A simple t-test analysis was
done comparing both the max temperatures, as well as the absolute
temperature change for each group.
Results: A total of 145 patients were included in the analysis. 72 patients in
the traditional ablation group had a mean max temperature of 37.6 + 1.39
˚C. Comparatively, the 73 patients in the HPSD group had a mean max
temperature of 37.3 + 0.646 ˚C, which was trending towards, but did not
achieve statistical significance (p=0.099). However, when comparing the
absolute temperature change, HPSD RFA demonstrated a significantly less
increase in temperature than the traditional RFA (1.14 + 0.48 ˚C vs.
1.69 + 0.60 ˚C (p< 0.0001)).
Conclusions: HPSD RFA resulted in a significantly lower esophageal temperature
change likely due to less distal conductive heating. Studies suggest
numerically less atrioesophageal fistula (AEF) with HPSD, albeit it the
numbers are small. With an increasing prevalence of HPSD RFA being used
significantly less AEF may be seen in AF ablation registries.