Introduction: To evaluate short-term efficacy and incidence of ablation-induced endoscopically detected esophageal injury in patients undergoing high-power, short-duration (HPSD) pulmonary vein isolation using a novel irrigated radiofrequency ablation catheter and ablation generator setup.

Methods and Results: Atrial fibrillation (AF) patients, who underwent AF ablation using an irrigated radiofrequency ablation catheter specifically designed for a HPSD ablation approach (50 W, Ablation Index guided with a target of 350 at posterior wall), received post-ablation esophageal endoscopy one day after ablation.

In total 45 consecutive patients (67±10 years; 58% male; 42% paroxysmal AF) undergoing an AF catheter ablation using a specialized ablation catheter (QDOT, Biosense Webster), were included in the study. Thirty one of 45 patients (69%) underwent a first-time pulmonary vein isolation (group 1, 67 ± 11 years; 55% male; 48% paroxysmal AF). Fourteen patients (31%) underwent a redo AF procedure (group 2, 66±8 years; 64% male; 29% paroxysmal AF). In group 1 patients an endoscopically detected esophageal lesion (EDEL) was detected in 5 of 31 (16%) patients (erosion n=2, ulcer n=3) whereas no EDEL was demonstrated in group 2 patients. Mean contact force at posterior wall ablation sites was significantly lower in patients with postprocedural EDEL compared to patients without EDEL (11.9±0.8 g vs. 15.6±4.7 g).

Conclusion: PVI using a specialized high-power ablation catheter in conjunction with a HPSD ablation approach results in a 16% incidence of EDEL in first AF ablation candidates. This rate appears higher compared to historic groups treated with HPSD and regular contact force ablation catheters.