Endoscopic evaluation of the esophagus after catheter ablation of atrial fibrillation using contiguous and optimized radiofrequency applications.

Abstract Background The incidence of endoscopically detected esophageal lesions after pulmonary vein isolation (PVI) is as high as 18%. Intra-esophageal temperature rise (ITR) during ablation is a predictor for esophageal injury. Objective We recently described an ablation strategy aiming to enclose the PVs with contiguous, stable and optimized RF applications (referred to as CLOSE-PVI). We evaluated esophageal and peri-esophageal injury with endoscopy in patients revealing ITR during CLOSE-PVI. Methods 85 patients with ITR during CLOSE-PVI underwent endoscopy of the esophagus (with ultrasound in 38 patients). PVI consisted of contact force (CF)-guided encircling of the veins using 35W applications respecting strict criteria of intertag distance (≤6mm) and ablation index (AI 550au anterior wall, 400au posterior wall, 300au if ITR>38.5°C). Results Endoscopy was performed 9±4days after PVI. At the posterior wall, median power was 35W [IQR 35-35], application time 18±5s, CF 13±6g, AI 403±38au. Median 5 applications [IQR 4-7] per patient over a length of 21.8±6.8mm resulted in ITR>38.5°C (median 39.9°C, IQR 39.2-41.2°C, range 38.6-50.0°C). For these applications median power was 35W [IQR 30-35], application time 14±3s, CF 12±5g, AI 351±38au. The incidence of esophageal erythema/erosion on endoscopy was 1/85 (1.2%) and of ulceration 0/85 (0%). The incidence of mediastinal or esophageal injury on ultrasound was 0/38 (0%). Conclusions The occurrence of esophageal or peri-esophageal injury after CLOSE-PVI is markedly low (1.2%). Absence of esophageal ulceration in patients with ITR suggests that this strategy of delivering contiguous, relatively high-power, and short-duration applications at the posterior wall is safe.