Esophageal Heating and Damage With High-Power-Short-Duration Radiofrequency and Pulsed Field Ablation

Area of Science:

• Cardiovascular Interventions
• Electrophysiology
• Medical Device Technology

Background:

• High-power short-duration (HPSD) radiofrequency ablation (RFA) and pulsed-field ablation (PFA) aim to minimize esophageal injury.
• The precise risk of esophageal heating and damage with these techniques remains uncertain.

Purpose of the Study:

• To evaluate luminal esophageal temperature (LET) changes and esophageal injury risk associated with HPSD-RFA and PFA.
• To compare the safety profiles of different ablation strategies in esophageal proximity.

Main Methods:

• In vivo swine models underwent pulmonary vein ablation using HPSD-RFA (50W/10s or 90W/4s) or PFA (STSF Dual Energy or Omnypulse catheters).
• Ex vivo swine esophagi were used for comparative analysis.
• Luminal esophageal temperature (LET), temperature rise rate (dT/dt), and histological outcomes (acute and 1-month) were assessed.

Main Results:

• HPSD-RFA at 50W/10s resulted in higher peak LET and dT/dt compared to 90W/4s, with 50W/10s causing persistent mucosal lesions.
• PFA with the STSF catheter showed higher peak LET and dT/dt than with the Omnypulse catheter; acute muscularis externa lesions occurred with PFA but were not detectable at 30 days.
• Ex vivo studies indicated comparable LET rises between RFA and PFA-STSF.

Conclusions:

• Both HPSD-RFA and PFA can induce LET rises and acute esophageal damage.
• PFA-associated esophageal damage appears independent of thermal effects and resolves by 30 days.
• The findings suggest PFA may offer a safer alternative regarding long-term esophageal injury compared to HPSD-RFA.