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)?


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.


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.


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


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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