Introduction:

Aim of this study was to evaluate the incidence of ablation-induced endoscopically detected esophageal lesions and gastroparesis in patients undergoing high-power short-duration (HPSD) atrial fibrillation (AF) radiofrequency ablation using different target ablation index (AI) values at left atrial posterior wall.

Methods and Results:

Consecutive patients undergoing AF catheter ablation and post-ablation esophageal endoscopy from March 2021 to March 2022 were included. Radiofrequency catheter ablation was performed using high-power short-duration (HPSD) ablation (50 W, AI-guided with target AI values of 320 or 350 (group 1) and 380 (group 2) at posterior wall and 450 at all other left atrial ablation sites). Post-ablation esophageal endoscopy was performed one to three days after ablation.

In total, 233 patients (66 ± 9.6 years, 52% male, 49% paroxysmal AF) were included consecutively. In the first group (n=137) ablation at posterior LA wall was performed using a target AI value of 320 or 350, in the second group (n=96) a target AI value of 380 was chosen. Patient groups did not differ significantly regarding patient characteristics or procedural parameters.

Post-ablation esophageal endoscopy revealed endoscopically detected esophageal lesions (EDEL) or gastroparesis in 43 of 233 patients (18.5%) in the total cohort (13% in group 1 and 26% in group 2; p=0.02). Incidence of EDEL was 8% and 13% in group 1 and group 2, respectively. According to univariate and multivariate logistic analysis incidence of EDEL and/or gastroparesis was significantly higher in patients undergoing RF ablation with an AI target value of 380 compared to 320 / 350 at posterior LA wall.

Conclusion:
The incidence of EDEL or gastroparesis in patients undergoing HPSD AF catheter ablation in this patient cohort was 18.5%. The risk of EDEL and gastroparesis seems to increase significantly when choosing a slightly higher AI target value of 380 compared to 320 to 350 at posterior LA wall.