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Original articles
Published online: 2017-07-07
Submitted: 2016-07-13
Accepted: 2017-06-22
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The influence of ablation power reduction associated with esophagus location on pulmonary veins isolation results in patients with paroxysmal atrial fibrillation: six-month follow-up

Piotr Buchta, Krzysztof Myrda, Michał Skrzypek, Adam Wojtaszczyk, Barbara Budzyn, Mariusz Gąsior
DOI: 10.5603/KP.a2017.0137

open access

Ahead of print
Original articles
Published online: 2017-07-07
Submitted: 2016-07-13
Accepted: 2017-06-22

Abstract

Background: Catheter ablation of atrial fibrillation (AF) could be associated with a thermal esophageal (EO) injury. To avoid this complication intraluminal esophageal temperature monitoring and ablation power reduction at the areas with excessive heating could be used. However, the reduced energy could limit the ablation lesion depth, without creation of consist transmural scar and influence on long-term ablation results.

Aim: The primary goal was to evaluate the homogeneity of forced ablation power reduction due to excessive EO heating in different parts of left atrium. Secondary goal was to assess the influence of the power reduction in different EO locations on long-term AF recurrence.

Methods: We have examined retrospectively 109 consecutive patients with symptomatic, medically refractory paroxysmal AF, who underwent pulmonary veins isolation using RF ablation. In 40.4% of the patients the esophageal courses were central (group B) left atrium posterior wall, in 31.2% was left-sided (group A), 28.4% right – sided (group C). The maximal measured temperature (41.0±1.0 vs. 39.2±1.5 vs. 40.6±0.7°C) and forced ablation power (15.9±5.6 vs 23.5±6.1 vs. 17.4±5.7 W) differed significantly according to the esophageal course (A, B, C, respectively). In 6 – months follow-up 76.15 % patients were free of arrhythmias. There was no statistically important difference between groups (A-C) regarding the AF recurrence rate: 32.4% vs. 20.5% vs 19.4% (p=0.37).

Conclusions: The maximal intraluminal esophageal temperatures and the necessary level
of power reduction during atrial fibrillation ablation are inhomogeneous in different parts of the left atrium, however are not associated with different 6- month follow-up results.

Abstract

Background: Catheter ablation of atrial fibrillation (AF) could be associated with a thermal esophageal (EO) injury. To avoid this complication intraluminal esophageal temperature monitoring and ablation power reduction at the areas with excessive heating could be used. However, the reduced energy could limit the ablation lesion depth, without creation of consist transmural scar and influence on long-term ablation results.

Aim: The primary goal was to evaluate the homogeneity of forced ablation power reduction due to excessive EO heating in different parts of left atrium. Secondary goal was to assess the influence of the power reduction in different EO locations on long-term AF recurrence.

Methods: We have examined retrospectively 109 consecutive patients with symptomatic, medically refractory paroxysmal AF, who underwent pulmonary veins isolation using RF ablation. In 40.4% of the patients the esophageal courses were central (group B) left atrium posterior wall, in 31.2% was left-sided (group A), 28.4% right – sided (group C). The maximal measured temperature (41.0±1.0 vs. 39.2±1.5 vs. 40.6±0.7°C) and forced ablation power (15.9±5.6 vs 23.5±6.1 vs. 17.4±5.7 W) differed significantly according to the esophageal course (A, B, C, respectively). In 6 – months follow-up 76.15 % patients were free of arrhythmias. There was no statistically important difference between groups (A-C) regarding the AF recurrence rate: 32.4% vs. 20.5% vs 19.4% (p=0.37).

Conclusions: The maximal intraluminal esophageal temperatures and the necessary level
of power reduction during atrial fibrillation ablation are inhomogeneous in different parts of the left atrium, however are not associated with different 6- month follow-up results.

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Keywords

atrial fibrillation, catheter ablation, esophageal injury

About this article
Title

The influence of ablation power reduction associated with esophagus location on pulmonary veins isolation results in patients with paroxysmal atrial fibrillation: six-month follow-up

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Ahead of print

Published online

2017-07-07

DOI

10.5603/KP.a2017.0137

Keywords

atrial fibrillation
catheter ablation
esophageal injury

Authors

Piotr Buchta
Krzysztof Myrda
Michał Skrzypek
Adam Wojtaszczyk
Barbara Budzyn
Mariusz Gąsior

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