PMID- 30573123
OWN - NLM
STAT- MEDLINE
DCOM- 20191118
LR  - 20191118
IS  - 2405-5018 (Electronic)
IS  - 2405-500X (Linking)
VI  - 4
IP  - 12
DP  - 2018 Dec
TI  - High-Power Radiofrequency Catheter Ablation of Atrial Fibrillation: Using Late 
      Gadolinium Enhancement Magnetic Resonance Imaging as a Novel Index of Esophageal 
      Injury.
PG  - 1583-1594
LID - S2405-500X(18)30646-7 [pii]
LID - 10.1016/j.jacep.2018.07.017 [doi]
AB  - OBJECTIVES: This study retrospectively evaluated the feasibility and esophageal 
      thermal injury (ETI) patterns of high-power short-duration (HPSD) radiofrequency 
      atrial fibrillation (AF) ablation. BACKGROUND: ETI following AF ablation can lead 
      to serious complications. Little consensus exists on the optimal radiofrequency 
      power setting or on the optimal strategy to assess ETI. METHODS: A total of 687 
      patients undergoing first-time AF ablation with either HPSD ablation (50 W for 5 
      s, n = 574) or low-power long-duration ablation (LPLD, </=35 W for 10 to 30 s, n = 
      113) were analyzed. ETI was assessed by late gadolinium enhancement (LGE) 
      magnetic resonance imaging (MRI) within 24 h post-ablation. Patients with 
      moderate or severe esophageal LGE had a follow-up MRI within 24 h to 1 week, and 
      esophagogastroduodenoscopies were performed when significant gastrointestinal 
      symptoms or persistent LGE on repeat MRI was present. AF recurrence adjusted for 
      potential confounders was analyzed. RESULTS: The average age was 69.0 +/- 11.8 
      years in the group undergoing HPSD ablation versus 68.3 +/- 11.6 years in the LPLD 
      group (p = 0.554), with 67.1% versus 59.3% male (p = 0.111). Esophageal LGE 
      patterns were similar (64.8% vs. 57.5% none, 21.0% vs. 28.3% mild, 11.5% vs. 
      11.5% moderate, 2.8% vs. 2.7% severe for HPSD vs. LPLD, respectively; p = 0.370) 
      with no atrioesophageal fistulas. Mean procedure length was significantly shorter 
      in the HPSD group (149 +/- 65 min vs. 251 +/- 101 min; p < 0.001). AF recurrence 
      rates were similar in the 2 groups for the mean 2.5-year follow-up period 
      (adjusted, 42% vs. 41%; p = 0.571). CONCLUSIONS: HPSD ablation results in similar 
      ETI patterns, as assessed by same-day LGE MRI, compared with the LPLD setting but 
      with significantly shorter procedure times. Recurrence rates at 2.5-year 
      follow-up are similar.
CI  - Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Baher, Alex
AU  - Baher A
AD  - Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; 
      Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah.
FAU - Kheirkhahan, Mobin
AU  - Kheirkhahan M
AD  - Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah.
FAU - Rechenmacher, Stephen J
AU  - Rechenmacher SJ
AD  - Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
FAU - Marashly, Qussay
AU  - Marashly Q
AD  - Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah.
FAU - Kholmovski, Eugene G
AU  - Kholmovski EG
AD  - Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah; Utah Center for Advanced Imaging Research, University of Utah, 
      Salt Lake City, Utah; Department of Radiology and Imaging Sciences, University of 
      Utah, Salt Lake City, Utah.
FAU - Siebermair, Johannes
AU  - Siebermair J
AD  - Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah; Department of Medicine I, Grosshadern Clinic, University of 
      Munich, Munich, Germany; German Cardiovascular Research Center partner site, 
      Munich Heart Alliance, Munich, Germany.
FAU - Acharya, Madan
AU  - Acharya M
AD  - Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
FAU - Aljuaid, Mossab
AU  - Aljuaid M
AD  - Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.
FAU - Morris, Alan K
AU  - Morris AK
AD  - Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah.
FAU - Kaur, Gagandeep
AU  - Kaur G
AD  - Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah.
FAU - Han, Frederick T
AU  - Han FT
AD  - Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; 
      Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah.
FAU - Wilson, Brent D
AU  - Wilson BD
AD  - Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; 
      Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah.
FAU - Steinberg, Benjamin A
AU  - Steinberg BA
AD  - Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; 
      Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah.
FAU - Marrouche, Nassir F
AU  - Marrouche NF
AD  - Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; 
      Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah.
FAU - Chelu, Mihail G
AU  - Chelu MG
AD  - Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah; 
      Comprehensive Arrhythmia Research & Management Center, University of Utah, Salt 
      Lake City, Utah. Electronic address: mihail.chelu@hsc.utah.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20180926
PL  - United States
TA  - JACC Clin Electrophysiol
JT  - JACC. Clinical electrophysiology
JID - 101656995
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
CIN - JACC Clin Electrophysiol. 2018 Dec;4(12):1595-1597. PMID: 30573124
MH  - Aged
MH  - Aged, 80 and over
MH  - Atrial Fibrillation/*surgery
MH  - Catheter Ablation/*adverse effects
MH  - *Esophageal Diseases/diagnostic imaging/etiology
MH  - *Esophagus/diagnostic imaging/injuries
MH  - Female
MH  - Gadolinium/therapeutic use
MH  - Humans
MH  - Magnetic Resonance Imaging/*methods
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
OTO - NOTNLM
OT  - atrial fibrillation
OT  - esophageal injury
OT  - magnetic resonance imaging
OT  - power setting
OT  - radiofrequency ablation
OT  - thermal injury
EDAT- 2018/12/24 06:00
MHDA- 2019/11/19 06:00
CRDT- 2018/12/22 06:00
PHST- 2018/06/03 00:00 [received]
PHST- 2018/07/23 00:00 [revised]
PHST- 2018/07/26 00:00 [accepted]
PHST- 2018/12/22 06:00 [entrez]
PHST- 2018/12/24 06:00 [pubmed]
PHST- 2019/11/19 06:00 [medline]
AID - S2405-500X(18)30646-7 [pii]
AID - 10.1016/j.jacep.2018.07.017 [doi]
PST - ppublish
SO  - JACC Clin Electrophysiol. 2018 Dec;4(12):1583-1594. doi: 
      10.1016/j.jacep.2018.07.017. Epub 2018 Sep 26.