Esophageal safety in CLOSE‐guided 50 W high‐power‐short‐duration pulmonary vein isolation: The PREHEAT‐PVI‐registry

Introduction Pulmonary vein isolation (PVI) using high‐power‐short‐duration (HPSD) radiofrequency ablation (RF) is emerging as the standard of care for treatment of atrial fibrillation (AF). While procedural short‐term to midterm efficacy and efficiency are very promising, this registry aims to investigate esopahgeal safety using an optimized ablation approach. Methods In a single‐center experience, 388 consecutive standardized first‐time AF ablation were performed using a CLOSE‐guided‐fixed‐50 W‐circumferential PVI and substrate modification without intraprocedural esophageal temperature measurement. Three hundred patients underwent postprocedural esophageal endoscopy to diagnose and grade endoscopically detected esophageal lesions (EDEL) and were included in the analysis. Results EDEL were detected in 35 of 300 patients (11.6%), 25 of 35 were low‐grade Kansas‐city‐classification (KCC) 1 lesions with fast healing tendencies. Six patients suffered KCC 2a lesions, 4 patients had KCC 2b lesions (1.3% of all patients). No esophageal perforation or fistula formation was observed. Patient baseline characteristics, especially patients age, gender, and body mass index did not influence EDEL incidence. Additional posterior box isolation did not increase the incidence of EDEL. In patients diagnosed with EDEL, mean catheter contact force during posterior wall ablation was higher (11.9 ± 1.8 vs. 14.7 ± 3 g, p