title: The influence of varying energy settings on efficacy and safety of endoscopic pulmonary vein isolation.
abstract: BACKGROUND
  The optimal energy setting for endoscopic pulmonary vein (PV) isolation (PVI) has not yet been determined.
  
  
  OBJECTIVE
  To assess the influence of varying energy settings on the efficacy and safety of endoscopic PVI.
  
  
  METHODS
  In the current prospective study, 30 patients with paroxysmal atrial fibrillation were consented for PVI using the endoscopic ablation system. Ablation was performed by using 5.5 and 7.0 W (group A), 7.0 and 8.5 W (group B), and 8.5 and 10.0 W (group C) along the posterior and anterior portion of each PV, respectively. Intraluminal esophageal temperature was measured via a temperature probe with a cutoff of 38.5°C. Endoscopy was performed 2 days postablation.
  
  
  RESULTS
  After the completion of the initial circular lesion set, acute PVI was achieved in 25 of the 36 (69%) PVs in group A, in 29 of the 40 (73%) PVs in group B, and in 36 of the 40 (90%) PVs in group C, respectively. The rate of acute PVI was significantly higher in group C than in group A (P = .025) and group B (P = .045); there was no difference when comparing group A and group B (P = .77). Esophageal thermal lesions were detected in 0 of the 10 patients in group A, in 1 of the 10 (10%) patients in group B, and in 1 of the 10 (10%) patients in group C. Mean procedure and fluoroscopy times were 219 ±42 and 30 ± 10, 239 ± 61 and 38 ± 14, and 207 ± 31 and 28 ± 8 minutes for group A, B, and C, respectively.
  
  
  CONCLUSIONS
  The use of higher energy settings increases the efficacy of acute endoscopic ablation system-based PVI without comprising safety. Further investigation is mandatory before final conclusions can be drawn.
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany. AndreasMetzner1@web.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.forename: Erik
authors.initials: E
authors.lastname: Wissner
authors.forename: Bas
authors.initials: B
authors.lastname: Schoonderwoerd
authors.forename: Andre
authors.initials: A
authors.lastname: Burchard
authors.forename: Roland
authors.initials: R
authors.lastname: Tilz
authors.forename: Alexander
authors.initials: A
authors.lastname: Fürnkranz
authors.forename: Andreas
authors.initials: A
authors.lastname: Rillig
authors.forename: Shibu
authors.initials: S
authors.lastname: Mathew
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000208:Acute Disease; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D001831:Body Temperature; D017115:Catheter Ablation; D017548:Echocardiography, Transesophageal; D004869:Equipment Safety; D004947:Esophagus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery*; D013223:Statistics as Topic