open access

Vol 75, No 11 (2017)
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 oesophagus location on pulmonary vein 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
·
Kardiol Pol 2017;75(11):1171-1176.

open access

Vol 75, No 11 (2017)
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 oesophageal (EO) injury. To avoid this complication intraluminal EO 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 lasting 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 the left atrium. The secondary goal was to assess the influence of power reduction in different EO locations on long-term AF recurrence.

Methods: We examined retrospectively 109 consecutive patients with symptomatic, medically refractory paroxysmal AF, who underwent pulmonary vein isolation using radiofrequency ablation. In 40.4% of the patients the EO course was central (group B) left atrium posterior wall, in 31.2% it was left sided (group A), and in 28.4% it was right sided (group C).

Results: 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 EO course (A, B, C, respectively). In six-month follow-up 76.15% of patients were free of arrhythmias. There was no statistically significant 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 EO temperatures and the necessary level of power reduction during AF ablation are inhomogeneous in different parts of the left atrium, but they are not associated with different six-month follow-up results.

Abstract

Background: Catheter ablation of atrial fibrillation (AF) could be associated with a thermal oesophageal (EO) injury. To avoid this complication intraluminal EO 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 lasting 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 the left atrium. The secondary goal was to assess the influence of power reduction in different EO locations on long-term AF recurrence.

Methods: We examined retrospectively 109 consecutive patients with symptomatic, medically refractory paroxysmal AF, who underwent pulmonary vein isolation using radiofrequency ablation. In 40.4% of the patients the EO course was central (group B) left atrium posterior wall, in 31.2% it was left sided (group A), and in 28.4% it was right sided (group C).

Results: 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 EO course (A, B, C, respectively). In six-month follow-up 76.15% of patients were free of arrhythmias. There was no statistically significant 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 EO temperatures and the necessary level of power reduction during AF ablation are inhomogeneous in different parts of the left atrium, but they are not associated with different six-month follow-up results.

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Keywords

atrial fibrillation, catheter ablation, oesophageal injury

About this article
Title

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

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 75, No 11 (2017)

Pages

1171-1176

Published online

2017-07-07

DOI

10.5603/KP.a2017.0137

Bibliographic record

Kardiol Pol 2017;75(11):1171-1176.

Keywords

atrial fibrillation
catheter ablation
oesophageal injury

Authors

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

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