Background: High-power short duration (HPSD) ablation is emerging as an alternative to conventional ablation for pulmonary vein isolation (PVI). However, the esophageal injury is still one of the main safety issues to be concerned. The aim of this study was to determine the safety of HPSD-based PVI with specific emphasis on acute esophageal injury.

Methods: This is a prospective single-center study that enrolled patients with atrial fibrillation (AF), who underwent a first PVI and had documented symptomatic paroxysmal or persistent AF with the longest AF episode of less than 6-month duration. The HPSD (70 W with an ablation time of 5 s at posterior left atrium and 7 s at other areas) was accomplished by an open-irrigated ablation catheter (FlexAbility^TM Ablation Catheter, Abbott). No luminal esophageal temperature (LET) was performed.  Esophageal endoscopy on the following day after ablation was performed to detect and categorize endoscopically detected esophageal lesions (EDEL) in all patients. Freedoms from atrio-esophageal fistula, thermal esophageal injury and esophageal perforation were evaluated.

Results: Consecutive 55 patients (69.9 ± 9.2 years; 72.7% male; 45.5% paroxysmal AF) were included. All patients achieved acute PVI with median procedure time of 88 minutes and fluoroscopy time of 5.6 minutes. EDEL was identified in 4 (7.5%) patients. Three of them had a small erythematous lesion, graded as Kansas-city-classification (KCC) type 1. The other one had a superficial esophageal ulcer, graded as KCC type 2a. All required only conservative management and were free of any symptoms. No serious esophageal injury, including atrio-esophageal fistula and esophageal perforation occurred.

Conclusions: Regarding acute esophageal safety profile, 70 W-HPSD-based PVI with lesion duration of 5 s at posterior left atrium is save and efficient.