Impact of combining ablation index‐guided and very high‐power short‐duration ablation at posterior wall adjacent to esophagus during perioperative period on procedural factors

Abstract Introduction The impact of combining ablation index (AI)‐guided and very high‐power short‐duration (vHPSD) ablation on procedural factors at the posterior wall near the esophagus is unclear. Methods Atrial fibrillation patients who underwent initial ablation using three‐dimensional mapping were enrolled. Patients were classified into two groups: those who underwent only AI‐guided pulmonary vein isolation (PVI) (AI group) and those who underwent vHPSD ablation at the posterior wall adjacent to the esophagus in addition to AI‐guided PVI (AI + vHPSD group). Differences in myocardial injury, inflammation, procedural characteristics, and pulmonary vein (PV) reconnection patterns were assessed between the two groups. Results This study included 167 patients (AI group, 83 patients; AI+vHPSD group, 84 patients). No significant differences in high‐sensitive troponin I or changes in inflammatory markers between pre‐ and Postablation were observed in either group. Total application time and total application energy were significantly lower in the AI+vHPSD group than in the AI group ( p < 0.001 for both) despite no significant difference in the total number of applications between the groups. The incidence of esophagus temperature ≥40 degrees was significantly lower in the AI+vHPSD group than in the AI group ( p = 0.036). However, the incidence of PV reconnections near the esophagus was significantly higher in the AI+vHPSD group than in the AI group (11.9% vs 3.6%, p = 0.046), despite no significant difference in the incidence of PV reconnections overall. Conclusion The combination of AI‐guided PVI and vHPSD adjacent to the esophagus demonstrated reduced application energy requirements and maintained safety and effectiveness during the perioperative period.