Journal of arrhythmia · 2026
Efficacy and Safety of 60 W Versus 90 W, 4-s Radiofrequency Applications to the Esophagus-Adjacent Left Atrial Posterior Wall During Pulmonary Vein Isolation: A Pilot Study.
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Okamatsu Hideharu, Okumura Ken, Tomaru Kakeru, Matsura Junya, Negishi Kodai, Tsurugi Takuo, Tanaka Yasuaki, Uehara Masayoshi, Koyama Junjiro, Tomita Hirofumi
Аннотация
BACKGROUND: In very high-power (51-90 W), short-duration (4 s) radiofrequency applications (QMODE+) using the QDOT MICRO catheter, the optimal power setting at the left atrial (LA) posterior wall adjacent to the esophagus for treating atrial fibrillation (AF) remains unclear.
OBJECTIVE: We evaluated the efficacy and safety of 60 W versus 90 W QMODE+ radiofrequency applications in the periesophageal region.
METHODS: Fifty AF patients were randomized into two groups based on the QMODE+ power applied to the periesophageal region: 60 W (n = 24) and 90 W (n = 26). We compared the incidence of residual conduction gaps in the periesophageal region and endoscopic esophageal lesions, as well as the 1-year atrial tachyarrhythmia (AT) recurrence rate between the two groups.
RESULTS: Median contact force was significantly higher in the 60 W group than in the 90 W group (12.9 g [IQR 10.2, 15.8] in the 60 W group and 10.9 g [IQR 8.4, 14.2] in the 90 W group, p < 0.001). The rates of residual conduction gaps (8.3% and 11.5%, respectively, p = 1.00) and esophageal lesions (4.2% in each group) were similar between the two groups. The 1-year AT recurrence rate did not significantly differ between the two groups (20.8% vs. 7.7%, respectively, p = 0.24).
CONCLUSION: 60 W and 90 W QMODE+ RF applications for the periesophageal region achieved comparable rates of acute conduction block, endoscopy-detected esophageal injury, and 12-month AT recurrence-free survival, although contact force was significantly higher in the 60 W group.
TRIAL REGISTRATION: Japan Registry of Clinical Trials (jRCT); jRCT1072230115 (Registered on February 8, 2024).
OBJECTIVE: We evaluated the efficacy and safety of 60 W versus 90 W QMODE+ radiofrequency applications in the periesophageal region.
METHODS: Fifty AF patients were randomized into two groups based on the QMODE+ power applied to the periesophageal region: 60 W (n = 24) and 90 W (n = 26). We compared the incidence of residual conduction gaps in the periesophageal region and endoscopic esophageal lesions, as well as the 1-year atrial tachyarrhythmia (AT) recurrence rate between the two groups.
RESULTS: Median contact force was significantly higher in the 60 W group than in the 90 W group (12.9 g [IQR 10.2, 15.8] in the 60 W group and 10.9 g [IQR 8.4, 14.2] in the 90 W group, p < 0.001). The rates of residual conduction gaps (8.3% and 11.5%, respectively, p = 1.00) and esophageal lesions (4.2% in each group) were similar between the two groups. The 1-year AT recurrence rate did not significantly differ between the two groups (20.8% vs. 7.7%, respectively, p = 0.24).
CONCLUSION: 60 W and 90 W QMODE+ RF applications for the periesophageal region achieved comparable rates of acute conduction block, endoscopy-detected esophageal injury, and 12-month AT recurrence-free survival, although contact force was significantly higher in the 60 W group.
TRIAL REGISTRATION: Japan Registry of Clinical Trials (jRCT); jRCT1072230115 (Registered on February 8, 2024).