Efficacy and Safety of
                    <scp>60 W</scp>
                    Versus
                    <scp>90 W</scp>
                    , 4‐s Radiofrequency Applications to the Esophagus‐Adjacent Left Atrial Posterior Wall During Pulmonary Vein

doi:10.1002/joa3.70476

DOI: 10.1002/joa3.70476 ISSN: 1880-4276

Efficacy and Safety of 60 W Versus 90 W , 4‐s Radiofrequency Applications to the Esophagus‐Adjacent Left Atrial Posterior Wall During Pulmonary Vein

Hideharu Okamatsu, Ken Okumura, Kakeru Tomaru, Junya Matsura, Kodai Negishi, Takuo Tsurugi, Yasuaki Tanaka, Masayoshi Uehara, Junjiro Koyama, Hirofumi Tomita

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ABSTRACT

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)

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