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Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial)

AIMS: Radiofrequency (RF) ablation for pulmonary vein isolation (PVI) in atrial fibrillation (AF) is associated with the risk of oesophageal thermal injury (ETI). Higher power short duration (HPSD) ablation results in preferential local resistive heating over distal conductive heating. Although HPSD...

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Autores principales: Chieng, David, Segan, Louise, Sugumar, Hariharan, Al-Kaisey, Ahmed, Hawson, Joshua, Moore, Benjamin M, Nam, Michael C Y, Voskoboinik, Aleksandr, Prabhu, Sandeep, Ling, Liang-Han, Ng, Jer Fuu, Brown, Gregor, Lee, Geoffrey, Morton, Joseph, Debinski, Henry, Kalman, Jonathan M, Kistler, Peter M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9934996/
https://www.ncbi.nlm.nih.gov/pubmed/36305561
http://dx.doi.org/10.1093/europace/euac190
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author Chieng, David
Segan, Louise
Sugumar, Hariharan
Al-Kaisey, Ahmed
Hawson, Joshua
Moore, Benjamin M
Nam, Michael C Y
Voskoboinik, Aleksandr
Prabhu, Sandeep
Ling, Liang-Han
Ng, Jer Fuu
Brown, Gregor
Lee, Geoffrey
Morton, Joseph
Debinski, Henry
Kalman, Jonathan M
Kistler, Peter M
author_facet Chieng, David
Segan, Louise
Sugumar, Hariharan
Al-Kaisey, Ahmed
Hawson, Joshua
Moore, Benjamin M
Nam, Michael C Y
Voskoboinik, Aleksandr
Prabhu, Sandeep
Ling, Liang-Han
Ng, Jer Fuu
Brown, Gregor
Lee, Geoffrey
Morton, Joseph
Debinski, Henry
Kalman, Jonathan M
Kistler, Peter M
author_sort Chieng, David
collection PubMed
description AIMS: Radiofrequency (RF) ablation for pulmonary vein isolation (PVI) in atrial fibrillation (AF) is associated with the risk of oesophageal thermal injury (ETI). Higher power short duration (HPSD) ablation results in preferential local resistive heating over distal conductive heating. Although HPSD has become increasingly common, no randomized study has compared ETI risk with conventional lower power longer duration (LPLD) ablation. This study aims to compare HPSD vs. LPLD ablation on ETI risk. METHODS AND RESULTS: Eighty-eight patients were randomized 1:1 to HPSD or LPLD posterior wall (PW) ablation. Posterior wall ablation was 40 W (HPSD group) or 25 W (LPLD group), with target AI (ablation index) 400/LSI (lesion size index) 4. Anterior wall ablation was 40–50 W, with a target AI 500–550/LSI 5–5.5. Endoscopy was performed on Day 1. The primary endpoint was ETI incidence. The mean age was 61 ± 9 years (31% females). The incidence of ETI (superficial ulcers n = 4) was 4.5%, with equal occurrence in HPSD and LPLD (P = 1.0). There was no difference in the median value of maximal oesophageal temperature (HPSD 38.6°C vs. LPLD 38.7°C, P = 0.43), or the median number of lesions per patient with temperature rise above 39°C (HPSD 1.5 vs. LPLD 2, P = 0.93). Radiofrequency ablation time (23.8 vs. 29.7 min, P < 0.01), PVI duration (46.5 vs. 59 min, P = 0.01), and procedure duration (133 vs. 150 min, P = 0.05) were reduced in HPSD. After a median follow-up of 12 months, AF recurrence was lower in HPSD (15.9% vs. LPLD 34.1%; hazard ratio 0.42, log-rank P = 0.04). CONCLUSION: Higher power short duration ablation was associated with similarly low rates of ETI and shorter total/PVI RF ablation times when compared with LPLD ablation. Higher power short duration ablation is a safe and efficacious approach to PVI.
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spelling pubmed-99349962023-02-17 Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial) Chieng, David Segan, Louise Sugumar, Hariharan Al-Kaisey, Ahmed Hawson, Joshua Moore, Benjamin M Nam, Michael C Y Voskoboinik, Aleksandr Prabhu, Sandeep Ling, Liang-Han Ng, Jer Fuu Brown, Gregor Lee, Geoffrey Morton, Joseph Debinski, Henry Kalman, Jonathan M Kistler, Peter M Europace Clinical Research AIMS: Radiofrequency (RF) ablation for pulmonary vein isolation (PVI) in atrial fibrillation (AF) is associated with the risk of oesophageal thermal injury (ETI). Higher power short duration (HPSD) ablation results in preferential local resistive heating over distal conductive heating. Although HPSD has become increasingly common, no randomized study has compared ETI risk with conventional lower power longer duration (LPLD) ablation. This study aims to compare HPSD vs. LPLD ablation on ETI risk. METHODS AND RESULTS: Eighty-eight patients were randomized 1:1 to HPSD or LPLD posterior wall (PW) ablation. Posterior wall ablation was 40 W (HPSD group) or 25 W (LPLD group), with target AI (ablation index) 400/LSI (lesion size index) 4. Anterior wall ablation was 40–50 W, with a target AI 500–550/LSI 5–5.5. Endoscopy was performed on Day 1. The primary endpoint was ETI incidence. The mean age was 61 ± 9 years (31% females). The incidence of ETI (superficial ulcers n = 4) was 4.5%, with equal occurrence in HPSD and LPLD (P = 1.0). There was no difference in the median value of maximal oesophageal temperature (HPSD 38.6°C vs. LPLD 38.7°C, P = 0.43), or the median number of lesions per patient with temperature rise above 39°C (HPSD 1.5 vs. LPLD 2, P = 0.93). Radiofrequency ablation time (23.8 vs. 29.7 min, P < 0.01), PVI duration (46.5 vs. 59 min, P = 0.01), and procedure duration (133 vs. 150 min, P = 0.05) were reduced in HPSD. After a median follow-up of 12 months, AF recurrence was lower in HPSD (15.9% vs. LPLD 34.1%; hazard ratio 0.42, log-rank P = 0.04). CONCLUSION: Higher power short duration ablation was associated with similarly low rates of ETI and shorter total/PVI RF ablation times when compared with LPLD ablation. Higher power short duration ablation is a safe and efficacious approach to PVI. Oxford University Press 2022-10-28 /pmc/articles/PMC9934996/ /pubmed/36305561 http://dx.doi.org/10.1093/europace/euac190 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research
Chieng, David
Segan, Louise
Sugumar, Hariharan
Al-Kaisey, Ahmed
Hawson, Joshua
Moore, Benjamin M
Nam, Michael C Y
Voskoboinik, Aleksandr
Prabhu, Sandeep
Ling, Liang-Han
Ng, Jer Fuu
Brown, Gregor
Lee, Geoffrey
Morton, Joseph
Debinski, Henry
Kalman, Jonathan M
Kistler, Peter M
Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial)
title Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial)
title_full Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial)
title_fullStr Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial)
title_full_unstemmed Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial)
title_short Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial)
title_sort higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (hi-lo heat trial)
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9934996/
https://www.ncbi.nlm.nih.gov/pubmed/36305561
http://dx.doi.org/10.1093/europace/euac190
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