Introduction: To evaluate short-term safety focusing on ablation-induced endoscopically detected esophageal injury in patients undergoing very-high-power, very-short-duration (vHPvSD) pulmonary vein isolation using a novel irrigated radiofrequency ablation catheter in conjunction with a novel ablation generator.

Methods and Results: Atrial fibrillation (AF) patients, who underwent AF ablation using an irrigated radiofrequency ablation catheter specifically designed for a vHPvSD ablation approach (90 Watts, with a predefined ablation time of 3 seconds at posterior wall and 4 seconds at other ablation sites), received post-ablation esophageal endoscopy one day after ablation and in a subgroup of patients a cerebral MR imaging.

In total 30 consecutive patients (67±9 years; 60% male; 63% paroxysmal AF) undergoing an AF catheter ablation using a specialized ablation catheter (QDOT, Biosense Webster) in conjunction with a novel ablation generator (nGEN, Biosense Webster), were included in the study. All of these patients underwent a first-time pulmonary vein isolation. In none of these patients an endoscopically detected esophageal lesion (EDEL) was detected. In 3 of 12 patients (25%) also undergoing cerebral MR imaging post-ablation acute cerebral silent events were detected. No relevant peri- or post-procedural complications were detected during a mean short-term FU of 42±19 days.

Conclusion: PVI using a specialized high-power ablation catheter in conjunction with a vHPvSD ablation approach with 90 Watts ablation power and 3 or 4 seconds ablation time resulted in an 0% incidence of EDEL in first AF ablation candidates. Compared to existing data this very low rate of EDEL in a relatively small patient cohort is remarkable. Of course, these are preliminary non-randomized results of a small retrospective study.