Incidence and predictors of thermal oesophageal and vagus nerve injuries in Ablation Index-guided high-power-short-duration ablation of atrial fibrillation: a prospective study
High-power-short-duration (HPSD) ablation is an effective treatment for atrial fibrillation but poses risks of thermal injuries to the oesophagus and vagus nerve. This study aims to investigate incidence and predictors of thermal injuries, employing machine learning. A prospective observational stud...
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| Veröffentlicht in: | Europace (London, England) England), 2024-05, Vol.26 (5) |
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| creator | Wolff, Charlotte Langenhan, Katharina Wolff, Marc Efimova, Elena Zachäus, Markus Darma, Angeliki Dinov, Borislav Seewöster, Timm Nedios, Sotirios Bertagnolli, Livio Wolff, Jan Paetsch, Ingo Jahnke, Cosima Bollmann, Andreas Hindricks, Gerhard Bode, Kerstin Halm, Ulrich Arya, Arash |
| description | High-power-short-duration (HPSD) ablation is an effective treatment for atrial fibrillation but poses risks of thermal injuries to the oesophagus and vagus nerve. This study aims to investigate incidence and predictors of thermal injuries, employing machine learning.
A prospective observational study was conducted at Leipzig Heart Centre, Germany, excluding patients with multiple prior ablations. All patients received Ablation Index-guided HPSD ablation and subsequent oesophagogastroduodenoscopy. A machine learning algorithm categorized ablation points by atrial location and analysed ablation data, including Ablation Index, focusing on the posterior wall. The study is registered in clinicaltrials.gov (NCT05709756). Between February 2021 and August 2023, 238 patients were enrolled, of whom 18 (7.6%; nine oesophagus, eight vagus nerve, one both) developed thermal injuries, including eight oesophageal erythemata, two ulcers, and no fistula. Higher mean force (15.8 ± 3.9 g vs. 13.6 ± 3.9 g, P = 0.022), ablation point quantity (61.50 ± 20.45 vs. 48.16 ± 19.60, P = 0.007), and total and maximum Ablation Index (24 114 ± 8765 vs. 18 894 ± 7863, P = 0.008; 499 ± 95 vs. 473 ± 44, P = 0.04, respectively) at the posterior wall, but not oesophagus location, correlated significantly with thermal injury occurrence. Patients with thermal injuries had significantly lower distances between left atrium and oesophagus (3.0 ± 1.5 mm vs. 4.4 ± 2.1 mm, P = 0.012) and smaller atrial surface areas (24.9 ± 6.5 cm2 vs. 29.5 ± 7.5 cm2, P = 0.032).
The low thermal lesion's rate (7.6%) during Ablation Index-guided HPSD ablation for atrial fibrillation is noteworthy. Machine learning based ablation data analysis identified several potential predictors of thermal injuries. The correlation between machine learning output and injury development suggests the potential for a clinical tool to enhance procedural safety. |
| doi_str_mv | 10.1093/europace/euae107 |
| format | Article |
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A prospective observational study was conducted at Leipzig Heart Centre, Germany, excluding patients with multiple prior ablations. All patients received Ablation Index-guided HPSD ablation and subsequent oesophagogastroduodenoscopy. A machine learning algorithm categorized ablation points by atrial location and analysed ablation data, including Ablation Index, focusing on the posterior wall. The study is registered in clinicaltrials.gov (NCT05709756). Between February 2021 and August 2023, 238 patients were enrolled, of whom 18 (7.6%; nine oesophagus, eight vagus nerve, one both) developed thermal injuries, including eight oesophageal erythemata, two ulcers, and no fistula. Higher mean force (15.8 ± 3.9 g vs. 13.6 ± 3.9 g, P = 0.022), ablation point quantity (61.50 ± 20.45 vs. 48.16 ± 19.60, P = 0.007), and total and maximum Ablation Index (24 114 ± 8765 vs. 18 894 ± 7863, P = 0.008; 499 ± 95 vs. 473 ± 44, P = 0.04, respectively) at the posterior wall, but not oesophagus location, correlated significantly with thermal injury occurrence. Patients with thermal injuries had significantly lower distances between left atrium and oesophagus (3.0 ± 1.5 mm vs. 4.4 ± 2.1 mm, P = 0.012) and smaller atrial surface areas (24.9 ± 6.5 cm2 vs. 29.5 ± 7.5 cm2, P = 0.032).
The low thermal lesion's rate (7.6%) during Ablation Index-guided HPSD ablation for atrial fibrillation is noteworthy. Machine learning based ablation data analysis identified several potential predictors of thermal injuries. The correlation between machine learning output and injury development suggests the potential for a clinical tool to enhance procedural safety.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euae107</identifier><identifier>PMID: 38646922</identifier><language>eng</language><publisher>England</publisher><subject>Aged ; Atrial Fibrillation - epidemiology ; Atrial Fibrillation - surgery ; Burns - epidemiology ; Burns - etiology ; Catheter Ablation - adverse effects ; Catheter Ablation - methods ; Esophagus - injuries ; Esophagus - surgery ; Female ; Germany - epidemiology ; Humans ; Incidence ; Machine Learning ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Veins - surgery ; Risk Factors ; Time Factors ; Treatment Outcome ; Vagus Nerve ; Vagus Nerve Injuries - epidemiology ; Vagus Nerve Injuries - etiology</subject><ispartof>Europace (London, England), 2024-05, Vol.26 (5)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c252t-223db0671f0393cb6a06e2896c385b5d0b0ee4ff26f1bea950d013b4e188eb423</cites><orcidid>0000-0002-0132-0773 ; 0000-0002-1657-7897 ; 0000-0001-8616-1638 ; 0000-0002-2873-6779 ; 0000-0002-2851-8931 ; 0000-0002-3528-7174 ; 0000-0003-2750-0606 ; 0000-0003-4756-2775 ; 0009-0002-9114-9558 ; 0000-0003-4222-6633 ; 0000-0003-1104-8491 ; 0009-0005-9228-5545 ; 0000-0002-5441-3906 ; 0009-0005-7610-9314 ; 0000-0002-7615-014X ; 0000-0001-9145-3467</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38646922$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wolff, Charlotte</creatorcontrib><creatorcontrib>Langenhan, Katharina</creatorcontrib><creatorcontrib>Wolff, Marc</creatorcontrib><creatorcontrib>Efimova, Elena</creatorcontrib><creatorcontrib>Zachäus, Markus</creatorcontrib><creatorcontrib>Darma, Angeliki</creatorcontrib><creatorcontrib>Dinov, Borislav</creatorcontrib><creatorcontrib>Seewöster, Timm</creatorcontrib><creatorcontrib>Nedios, Sotirios</creatorcontrib><creatorcontrib>Bertagnolli, Livio</creatorcontrib><creatorcontrib>Wolff, Jan</creatorcontrib><creatorcontrib>Paetsch, Ingo</creatorcontrib><creatorcontrib>Jahnke, Cosima</creatorcontrib><creatorcontrib>Bollmann, Andreas</creatorcontrib><creatorcontrib>Hindricks, Gerhard</creatorcontrib><creatorcontrib>Bode, Kerstin</creatorcontrib><creatorcontrib>Halm, Ulrich</creatorcontrib><creatorcontrib>Arya, Arash</creatorcontrib><title>Incidence and predictors of thermal oesophageal and vagus nerve injuries in Ablation Index-guided high-power-short-duration ablation of atrial fibrillation: a prospective study</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>High-power-short-duration (HPSD) ablation is an effective treatment for atrial fibrillation but poses risks of thermal injuries to the oesophagus and vagus nerve. This study aims to investigate incidence and predictors of thermal injuries, employing machine learning.
A prospective observational study was conducted at Leipzig Heart Centre, Germany, excluding patients with multiple prior ablations. All patients received Ablation Index-guided HPSD ablation and subsequent oesophagogastroduodenoscopy. A machine learning algorithm categorized ablation points by atrial location and analysed ablation data, including Ablation Index, focusing on the posterior wall. The study is registered in clinicaltrials.gov (NCT05709756). Between February 2021 and August 2023, 238 patients were enrolled, of whom 18 (7.6%; nine oesophagus, eight vagus nerve, one both) developed thermal injuries, including eight oesophageal erythemata, two ulcers, and no fistula. Higher mean force (15.8 ± 3.9 g vs. 13.6 ± 3.9 g, P = 0.022), ablation point quantity (61.50 ± 20.45 vs. 48.16 ± 19.60, P = 0.007), and total and maximum Ablation Index (24 114 ± 8765 vs. 18 894 ± 7863, P = 0.008; 499 ± 95 vs. 473 ± 44, P = 0.04, respectively) at the posterior wall, but not oesophagus location, correlated significantly with thermal injury occurrence. Patients with thermal injuries had significantly lower distances between left atrium and oesophagus (3.0 ± 1.5 mm vs. 4.4 ± 2.1 mm, P = 0.012) and smaller atrial surface areas (24.9 ± 6.5 cm2 vs. 29.5 ± 7.5 cm2, P = 0.032).
The low thermal lesion's rate (7.6%) during Ablation Index-guided HPSD ablation for atrial fibrillation is noteworthy. Machine learning based ablation data analysis identified several potential predictors of thermal injuries. The correlation between machine learning output and injury development suggests the potential for a clinical tool to enhance procedural safety.</description><subject>Aged</subject><subject>Atrial Fibrillation - epidemiology</subject><subject>Atrial Fibrillation - surgery</subject><subject>Burns - epidemiology</subject><subject>Burns - etiology</subject><subject>Catheter Ablation - adverse effects</subject><subject>Catheter Ablation - methods</subject><subject>Esophagus - injuries</subject><subject>Esophagus - surgery</subject><subject>Female</subject><subject>Germany - epidemiology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Machine Learning</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prospective Studies</subject><subject>Pulmonary Veins - surgery</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Vagus Nerve</subject><subject>Vagus Nerve Injuries - epidemiology</subject><subject>Vagus Nerve Injuries - etiology</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kUlvFDEQhS1ERBa4c0I-cjGU7d7MLYpIGCkSl3BueamedjTTbryE5F_xE3E0M5zqqfTVqyc9Qj5y-MJBya9YYli1xSo0cujfkAveSsEEKPG2alCKtVyoc3KZ0iMA9EK178i5HLqmU0JckL-bxXqHi0WqF0fXiM7bHGKiYaJ5xrjXOxowhXXWW6z6lXrS25LogvEJqV8eS_SYqqDXZqezDwvdLA6f2bZUZ0dnv53ZGv5gZGkOMTNX4gHTJ77-0jn6aj95E_3usP5GdQ0U0oo2-_oq5eJe3pOzSe8SfjjOK_Lr9vvDzQ92__Nuc3N9z6xoRWZCSGeg6_kEUklrOg0dikF1Vg6taR0YQGymSXQTN6hVCw64NA3yYUDTCHlFPh98a4LfBVMe9z5ZrNEWDCWNEhrZ9woaqCgcUFvDpojTuEa_1_Fl5DC-9jSeehqPPdWTT0f3Yvbo_h-cipH_AIallrk</recordid><startdate>20240502</startdate><enddate>20240502</enddate><creator>Wolff, Charlotte</creator><creator>Langenhan, Katharina</creator><creator>Wolff, Marc</creator><creator>Efimova, Elena</creator><creator>Zachäus, Markus</creator><creator>Darma, Angeliki</creator><creator>Dinov, Borislav</creator><creator>Seewöster, Timm</creator><creator>Nedios, Sotirios</creator><creator>Bertagnolli, Livio</creator><creator>Wolff, Jan</creator><creator>Paetsch, Ingo</creator><creator>Jahnke, Cosima</creator><creator>Bollmann, Andreas</creator><creator>Hindricks, Gerhard</creator><creator>Bode, Kerstin</creator><creator>Halm, Ulrich</creator><creator>Arya, Arash</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0132-0773</orcidid><orcidid>https://orcid.org/0000-0002-1657-7897</orcidid><orcidid>https://orcid.org/0000-0001-8616-1638</orcidid><orcidid>https://orcid.org/0000-0002-2873-6779</orcidid><orcidid>https://orcid.org/0000-0002-2851-8931</orcidid><orcidid>https://orcid.org/0000-0002-3528-7174</orcidid><orcidid>https://orcid.org/0000-0003-2750-0606</orcidid><orcidid>https://orcid.org/0000-0003-4756-2775</orcidid><orcidid>https://orcid.org/0009-0002-9114-9558</orcidid><orcidid>https://orcid.org/0000-0003-4222-6633</orcidid><orcidid>https://orcid.org/0000-0003-1104-8491</orcidid><orcidid>https://orcid.org/0009-0005-9228-5545</orcidid><orcidid>https://orcid.org/0000-0002-5441-3906</orcidid><orcidid>https://orcid.org/0009-0005-7610-9314</orcidid><orcidid>https://orcid.org/0000-0002-7615-014X</orcidid><orcidid>https://orcid.org/0000-0001-9145-3467</orcidid></search><sort><creationdate>20240502</creationdate><title>Incidence and predictors of thermal oesophageal and vagus nerve injuries in Ablation Index-guided high-power-short-duration ablation of atrial fibrillation: a prospective study</title><author>Wolff, Charlotte ; Langenhan, Katharina ; Wolff, Marc ; Efimova, Elena ; Zachäus, Markus ; Darma, Angeliki ; Dinov, Borislav ; Seewöster, Timm ; Nedios, Sotirios ; Bertagnolli, Livio ; Wolff, Jan ; Paetsch, Ingo ; Jahnke, Cosima ; Bollmann, Andreas ; Hindricks, Gerhard ; Bode, Kerstin ; Halm, Ulrich ; Arya, Arash</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c252t-223db0671f0393cb6a06e2896c385b5d0b0ee4ff26f1bea950d013b4e188eb423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Atrial Fibrillation - epidemiology</topic><topic>Atrial Fibrillation - surgery</topic><topic>Burns - epidemiology</topic><topic>Burns - etiology</topic><topic>Catheter Ablation - adverse effects</topic><topic>Catheter Ablation - methods</topic><topic>Esophagus - injuries</topic><topic>Esophagus - surgery</topic><topic>Female</topic><topic>Germany - epidemiology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Machine Learning</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Prospective Studies</topic><topic>Pulmonary Veins - surgery</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Vagus Nerve</topic><topic>Vagus Nerve Injuries - epidemiology</topic><topic>Vagus Nerve Injuries - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wolff, Charlotte</creatorcontrib><creatorcontrib>Langenhan, Katharina</creatorcontrib><creatorcontrib>Wolff, Marc</creatorcontrib><creatorcontrib>Efimova, Elena</creatorcontrib><creatorcontrib>Zachäus, Markus</creatorcontrib><creatorcontrib>Darma, Angeliki</creatorcontrib><creatorcontrib>Dinov, Borislav</creatorcontrib><creatorcontrib>Seewöster, Timm</creatorcontrib><creatorcontrib>Nedios, Sotirios</creatorcontrib><creatorcontrib>Bertagnolli, Livio</creatorcontrib><creatorcontrib>Wolff, Jan</creatorcontrib><creatorcontrib>Paetsch, Ingo</creatorcontrib><creatorcontrib>Jahnke, Cosima</creatorcontrib><creatorcontrib>Bollmann, Andreas</creatorcontrib><creatorcontrib>Hindricks, Gerhard</creatorcontrib><creatorcontrib>Bode, Kerstin</creatorcontrib><creatorcontrib>Halm, Ulrich</creatorcontrib><creatorcontrib>Arya, Arash</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wolff, Charlotte</au><au>Langenhan, Katharina</au><au>Wolff, Marc</au><au>Efimova, Elena</au><au>Zachäus, Markus</au><au>Darma, Angeliki</au><au>Dinov, Borislav</au><au>Seewöster, Timm</au><au>Nedios, Sotirios</au><au>Bertagnolli, Livio</au><au>Wolff, Jan</au><au>Paetsch, Ingo</au><au>Jahnke, Cosima</au><au>Bollmann, Andreas</au><au>Hindricks, Gerhard</au><au>Bode, Kerstin</au><au>Halm, Ulrich</au><au>Arya, Arash</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and predictors of thermal oesophageal and vagus nerve injuries in Ablation Index-guided high-power-short-duration ablation of atrial fibrillation: a prospective study</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2024-05-02</date><risdate>2024</risdate><volume>26</volume><issue>5</issue><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>High-power-short-duration (HPSD) ablation is an effective treatment for atrial fibrillation but poses risks of thermal injuries to the oesophagus and vagus nerve. This study aims to investigate incidence and predictors of thermal injuries, employing machine learning.
A prospective observational study was conducted at Leipzig Heart Centre, Germany, excluding patients with multiple prior ablations. All patients received Ablation Index-guided HPSD ablation and subsequent oesophagogastroduodenoscopy. A machine learning algorithm categorized ablation points by atrial location and analysed ablation data, including Ablation Index, focusing on the posterior wall. The study is registered in clinicaltrials.gov (NCT05709756). Between February 2021 and August 2023, 238 patients were enrolled, of whom 18 (7.6%; nine oesophagus, eight vagus nerve, one both) developed thermal injuries, including eight oesophageal erythemata, two ulcers, and no fistula. Higher mean force (15.8 ± 3.9 g vs. 13.6 ± 3.9 g, P = 0.022), ablation point quantity (61.50 ± 20.45 vs. 48.16 ± 19.60, P = 0.007), and total and maximum Ablation Index (24 114 ± 8765 vs. 18 894 ± 7863, P = 0.008; 499 ± 95 vs. 473 ± 44, P = 0.04, respectively) at the posterior wall, but not oesophagus location, correlated significantly with thermal injury occurrence. Patients with thermal injuries had significantly lower distances between left atrium and oesophagus (3.0 ± 1.5 mm vs. 4.4 ± 2.1 mm, P = 0.012) and smaller atrial surface areas (24.9 ± 6.5 cm2 vs. 29.5 ± 7.5 cm2, P = 0.032).
The low thermal lesion's rate (7.6%) during Ablation Index-guided HPSD ablation for atrial fibrillation is noteworthy. Machine learning based ablation data analysis identified several potential predictors of thermal injuries. The correlation between machine learning output and injury development suggests the potential for a clinical tool to enhance procedural safety.</abstract><cop>England</cop><pmid>38646922</pmid><doi>10.1093/europace/euae107</doi><orcidid>https://orcid.org/0000-0002-0132-0773</orcidid><orcidid>https://orcid.org/0000-0002-1657-7897</orcidid><orcidid>https://orcid.org/0000-0001-8616-1638</orcidid><orcidid>https://orcid.org/0000-0002-2873-6779</orcidid><orcidid>https://orcid.org/0000-0002-2851-8931</orcidid><orcidid>https://orcid.org/0000-0002-3528-7174</orcidid><orcidid>https://orcid.org/0000-0003-2750-0606</orcidid><orcidid>https://orcid.org/0000-0003-4756-2775</orcidid><orcidid>https://orcid.org/0009-0002-9114-9558</orcidid><orcidid>https://orcid.org/0000-0003-4222-6633</orcidid><orcidid>https://orcid.org/0000-0003-1104-8491</orcidid><orcidid>https://orcid.org/0009-0005-9228-5545</orcidid><orcidid>https://orcid.org/0000-0002-5441-3906</orcidid><orcidid>https://orcid.org/0009-0005-7610-9314</orcidid><orcidid>https://orcid.org/0000-0002-7615-014X</orcidid><orcidid>https://orcid.org/0000-0001-9145-3467</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Europace (London, England), 2024-05, Vol.26 (5) |
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| source | MEDLINE; Oxford Journals Open Access Collection; PubMed Central; Alma/SFX Local Collection |
| subjects | Aged Atrial Fibrillation - epidemiology Atrial Fibrillation - surgery Burns - epidemiology Burns - etiology Catheter Ablation - adverse effects Catheter Ablation - methods Esophagus - injuries Esophagus - surgery Female Germany - epidemiology Humans Incidence Machine Learning Male Middle Aged Prospective Studies Pulmonary Veins - surgery Risk Factors Time Factors Treatment Outcome Vagus Nerve Vagus Nerve Injuries - epidemiology Vagus Nerve Injuries - etiology |
| title | Incidence and predictors of thermal oesophageal and vagus nerve injuries in Ablation Index-guided high-power-short-duration ablation of atrial fibrillation: a prospective study |
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