Abstract 14986: Incidence Of Esophageal Lesions Following Robotic As Compared To Manual Pulmonary Vein Isolation Using Different Temperature Cutoff Values -data Of A Prospective Multicenter Trial-

Background The incidence of esophageal lesions (EL) following circumferential pulmonary vein isolation (CPVI) using a remote Robotic Navigation System (RNS) compared to manual ablation has only be evaluated in a small cohort of patients (pt). The impact of different temperature cut-offs (TC) on the incidence of ELs has not been evaluated. The aim of this prospective multicenter trial was to compare the incidence of EL using different TCs following either robotic or manual CPVI. Methods In 245 patients (pts, 86 female,35%; median age 63 years (54-69 years)) with paroxysmal (n=167, 68,2%) or persistent AF solely CPVI was performed using either the RNS (group 1, n=150, 61,2%) or manual ablation (group 2, n=95). Both groups were divided into two subgroups with different TCs (39°C: group 1a (n=46) + group 2a (n=41); 41°C: group 1b (n=49) + group 2b (n=109). CPVI was performed using a 3.5mm irrigated tip RF ablation catheter in combination with a 3D mapping system using max 20 watts at the posterior wall of the left atriuk (LA) in the robotic group and max 30W in the manual group. In all patients esophageal temperature was monitored throughout the procedure with two different TCs (≤ 39°C and ≤ 41°C). Assessment of EL was performed by endoscopy 2 days after PVI. Results The incidence of EL was similar comparing group 1 with group 2 (21/150, 14% vs 15/95, 15,8%; p=0,7) as was the incidence of esophageal ulcerations (EU; n=5/150, 3,3% vs n=3/95, 3,2%; p=1,0). Comparing the two TCs (39°C vs 41°C) no significant difference between ocurrence of EL (13/87, 14,9% vs 23/158, 14,6%; p=0,93) or EU (1/87, 1,1% vs 7/158, 4,4%; p=0,27) was found. Comparing group 1a with group 2a a non-significant trend to a higher incidence of EL was seen in the robotic group (4/46, 8,7% vs 9/41, 21,2%; p=0,083); in contrast when comparing group 1b with group 2b a strong trend was seen to a higher incidence of ELs in the manual group (11/49, 22,4% vs 12/109, 11,0%; p=0,059). All ELs recovered without sequelae. No atrio-esophageal fistula occurred. Conclusion This study shows that when CPVI is performed using a RNS with 20 watts at the posterior wall of the LA the incidence and quality of EL is comparable to manual ablation with 30 watts. The number of EL was not significantly different in the two TC groups.