The Influence of Varying Energy Settings on Efficacy and Safety of Endoscopic Pulmonary Vein Isolation

Study Questions:

What is the influence of varying energy settings on the efficacy and safety of endoscopic pulmonary vein (PV) isolation (PVI)?

Methods:

In the current prospective study, 30 patients with paroxysmal atrial fibrillation were consented for PVI using the endoscopic ablation system. Ablation was performed by using 5.5 and 7.0 W (group A), 7.0 and 8.5 W (group B), and 8.5 and 10.0 W (group C) along the posterior and anterior portion of each PV, respectively. Intraluminal esophageal temperature was measured via a temperature probe with a cutoff of 38.5°C. Endoscopy was performed 2 days postablation.

Results:

After the completion of the initial circular lesion set, acute PVI was achieved in 25 of the 36 (69%) PVs in group A, in 29 of the 40 (73%) PVs in group B, and in 36 of the 40 (90%) PVs in group C, respectively. The rate of acute PVI was significantly higher in group C than in group A (p = 0.025) and group B (p = 0.045); there was no difference when comparing group A and group B (p = 0.77). Esophageal thermal lesions were detected in 0 of the 10 patients in group A, in 1 of the 10 (10%) patients in group B, and in 1 of the 10 (10%) patients in group C. Mean procedure and fluoroscopy times were 219 ± 42 and 30 ± 10, 239 ± 61 and 38 ± 14, and 207 ± 31 and 28 ± 8 minutes for groups A, B, and C, respectively.

Conclusions:

The authors concluded that the use of higher energy settings increases the efficacy of acute endoscopic ablation system–based PVI without comprising safety.

Perspective:

The study reports that the use of greater energy levels is more effective with a statistically significant higher success rate for a single circular lesion set to result in acute PVI, and that greater energy levels do not appear to correlate with a higher rate of injury to adjacent structures. The current study enrolled a small number of patients with a short clinical follow-up. Therefore, larger studies and longer follow-up periods are needed to assess the long-term benefit of higher energy levels on the rate of recurrence and clinical improvement, and also to further evaluate the risk of collateral damage to adjacent structures.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Nuclear Imaging

Keywords: Temperature, Fluoroscopy, Recurrence, Follow-Up Studies, Pulmonary Veins, Endoscopy, Risk Factors, Heart Rate, Catheter Ablation


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