Xi Zhang1, Xiaohui Kuang1, Xiaolong Gao1, Hong Xiang1, Feiyu Wei1, Tong Liu2, Haiyan Wu1, Gang Wang3, Zan Zuo4, Lilin Wang1, Liqun Ding1, Jin Zhang1, Michael Shehata5, Xunzhang Wang5, Bing Yang6, Jie Fan1. 1. Yunnan Arrhythmia Research Center, Division of Cardiology, the First People’s Hospital of Yunnan Province, the Affiliated Hospital of Kunming University of Science and Technology, People’s Republic of China (X.Z., X.K., X.G., H.X., F.W., H.W., L.W., L.D., J.Z., J.F.). 2. Division of Cardiology, the Second Affiliated Hospital of Tianjin Medical University, People’s Republic of China (T.L.). 3. Division of Radiology (G.W.), the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China. 4. Division of Gastroenterology (Z.Z.), the First People’s Hospital of Yunnan Province, Kunming, People’s Republic of China. 5. The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.S., X.W.). 6. Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province, People’s Republic of China (B.Y.).
Abstract
BACKGROUND: Although contact force (CF)–sensing catheters improve procedural effectiveness and safety of atrial fibrillation ablation, recent reports documented a higher incidence of atrioesophageal fistula formation relative to ablation with non–CF-sensing catheters.The present study was to assess whether restricting CF to <20 g reduced risk for esophageal injury (EI) in patients with atrial fibrillation undergoing circumferential pulmonary vein isolation. METHODS: This prospective, single-center, randomized study enrolled 89 consecutive patients (mean age, 57.2±11.3 years; 57.3% men) with atrial fibrillation (68.5% paroxysmal and 31.5% persistent). Computed tomography angiography, transesophageal echocardiography, and esophageal endoscopy were conducted before the procedure, and a repeat esophageal endoscopy was performed after the procedure. Patients were randomized to restricted-CF group (n=44) or non-CF group (n=45), with circumferential pulmonary vein isolation using a CF-sensing (CF restricted to <20 g) or non–CF-sensing catheter, respectively. The primary end point was rate of EI post ablation. RESULTS: Baseline characteristics were evenly distributed between groups, without a case of preprocedural EI. With the same power setting, similar ablation time and average measured catheter tip temperature during posterior wall ablation just opposite to the esophagus in all patients in the restricted-CF group versus non-CF groups, there were no cases versus 9 (20%) cases of EI post ablation, respectively, with similar rate of freedom from atrial tachyarrhythmias at mean 31.3±6.5 months follow-up (68.2% versus 64.4%; P=0.3798). CONCLUSIONS: Risk for EI was minimized when CF was restricted to <20 g at the posterior left atrial wall, where the circumferential pulmonary vein isolation lesion set and the course of the esophagus overlapped in all subjects.
RCT Entities:
BACKGROUND: Although contact force (CF)–sensing catheters improve procedural effectiveness and safety of atrial fibrillation ablation, recent reports documented a higher incidence of atrioesophageal fistula formation relative to ablation with non–CF-sensing catheters.The present study was to assess whether restricting CF to <20 g reduced risk for esophageal injury (EI) in patients with atrial fibrillation undergoing circumferential pulmonary vein isolation. METHODS: This prospective, single-center, randomized study enrolled 89 consecutive patients (mean age, 57.2±11.3 years; 57.3% men) with atrial fibrillation (68.5% paroxysmal and 31.5% persistent). Computed tomography angiography, transesophageal echocardiography, and esophageal endoscopy were conducted before the procedure, and a repeat esophageal endoscopy was performed after the procedure. Patients were randomized to restricted-CF group (n=44) or non-CF group (n=45), with circumferential pulmonary vein isolation using a CF-sensing (CF restricted to <20 g) or non–CF-sensing catheter, respectively. The primary end point was rate of EI post ablation. RESULTS: Baseline characteristics were evenly distributed between groups, without a case of preprocedural EI. With the same power setting, similar ablation time and average measured catheter tip temperature during posterior wall ablation just opposite to the esophagus in all patients in the restricted-CF group versus non-CF groups, there were no cases versus 9 (20%) cases of EI post ablation, respectively, with similar rate of freedom from atrial tachyarrhythmias at mean 31.3±6.5 months follow-up (68.2% versus 64.4%; P=0.3798). CONCLUSIONS: Risk for EI was minimized when CF was restricted to <20 g at the posterior left atrial wall, where the circumferential pulmonary vein isolation lesion set and the course of the esophagus overlapped in all subjects.
Authors: Cheryl Teres; David Soto-Iglesias; Diego Penela; Giulio Falasconi; Daniel Viveros; Julia Meca-Santamaria; Aldo Bellido; Jose Alderete; Alfredo Chauca; Augusto Ordoñez; Julio Martí-Almor; Claudia Scherer; Alejandro Panaro; Julio Carballo; Óscar Cámara; Jose-Tomás Ortiz-Pérez; Antonio Berruezo Journal: J Interv Card Electrophysiol Date: 2022-07-21 Impact factor: 1.759
Authors: Lisa W M Leung; Abhay Bajpai; Zia Zuberi; Anthony Li; Mark Norman; Riyaz A Kaba; Zaki Akhtar; Banu Evranos; Hanney Gonna; Idris Harding; Manav Sohal; Nawaf Al-Subaie; John Louis-Auguste; Jamal Hayat; Mark M Gallagher Journal: Europace Date: 2021-02-05 Impact factor: 5.214