Background: Pulmonary vein isolation (PVI) using radiofrequency ablation is an effective treatment option for patients with atrial fibrillation (AF). Application of high power over a short period of time is reported to create more efficient lesions. This study aims to investigate the safety of high-power short-duration (HPSD) with emphasis on esophageal lesions after PVI.

Methods: Consecutive patients undergoing AF ablation with HPSD (50W; ablation index-guided; AI 350 for posterior wall ablation, AI 450 for anterior wall ablation) using the QDOT catheter were included. Periprocedural parameters and complications were recorded. Patients underwent post-ablation esophageal endoscopy to detect thermal esophageal injury. Short-term endpoints included intraprocedural reconnection of at least one PV after initial isolation, intrahospital AF recurrence and incidence of thermal esophageal injury. 

Results: A total of 587 patients underwent AF ablation with HPSD. Of them, 534 patients (68.3 ± 9.6 years; 58% male; 46% paroxysmal AF; 64% first PVI) underwent postprocedural esophageal endoscopy and were included in further analyses. Median procedure time was 80.4 ± 25.1 minutes with ablation times of 16.5 ± 10.2 minutes. Intraprocedural reconnection occurred in 14% and intrahospital AF recurrence in 8%. Thermal esophageal injury was detected in 31 patients (6%) (n=16 erosion, n=15 ulcera). In none of the patients esophageal perforation, esophagopericardial or atrioesophageal fistula occurred. One patient received a covered esophagusstent due to imminent perforation. 

Conclusions: Thermal esophageal lesions are common after HPSD AF ablation. However, all lesions could be treated without surgical therapy and none of the patients died.