Trial reportEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2023
Higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes: a prospective multi-centre randomized controlled study (Hi-Lo HEAT trial).
Trial report in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
31 citing papers in PubMed, 3 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Efficacy and Safety of Pulsed-Field Versus High-Power Short-Duration Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis With Reconstructed Time-to-Event Data.Journal of cardiovascular electrophysiology · 2025Pooled it
- High-power short-duration vs. conventional catheter ablation for atrial fibrillation: a meta-analysis and trial sequential analysis of randomized controlled trials.Frontiers in cardiovascular medicine · 2025Pooled it
- Efficacy and safety of high-power short-duration ablation for atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024Pooled it
- Very high-power short-duration using 70W and a flexible tip ablation catheter for pulmonary vein isolation: the POWER PULSE randomized controlled trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Trial
- Esophageal Temperature Monitoring during Atrial Fibrillation Ablation: A Randomized Study.Arquivos brasileiros de cardiologia · 2025Trial
- Esophageal heating characteristics of very high-power short duration radiofrequency ablation in a myocardial phantom model.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Oesophageal safety of high and very high power short duration pulmonary vein isolation: a randomized comparison of the 50 W and 90 W power settings-the HPSD oesophagus study.European heart journal open · 2026Article
- Minimizing Esophageal Heating During Radiofrequency Catheter Ablation.Journal of cardiovascular electrophysiology · 2026Article
- Impact of intracardiac echocardiography on radiofrequency catheter ablation for atrial fibrillation: a clinical study on procedural parameters and post-procedural recurrence.Frontiers in cardiovascular medicine · 2026Article
- Minimizing Atrioesophageal Fistula Risk After AF Ablation: Risk Factors, Prevention, and Emerging Mini-Thermal Technology.Pacing and clinical electrophysiology : PACE · 2025Review
- The Predictive Value of Real-World Cardiologist Performance (RWCP) Score in Atrial Fibrillation Recurrence Risk After Radiofrequency Ablation.Journal of cardiovascular electrophysiology · 2025Article
- Esophageal endoscopic findings after pulmonary vein and posterior wall isolation using pulsed field ablation: results from the Eso-PFA study.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025Observational
- Improved procedural efficiency of atrial fibrillation ablation using robotic magnetic navigation.Heart rhythm O2 · 2025Article
- Effectiveness and safety of different types of ablation modalities in patients with atrial fibrillation: a bayesian network meta-analysis from randomized controlled trials.Journal of cardiothoracic surgery · 2025Article
- Catheter ablation using pulsed-field energy: Advantages and limitations compared with conventional energy.Journal of arrhythmia · 2025Review
- Prediction of Ablation Index and Lesion Size Index for Local Impedance Drop-Guided Ablation.Journal of clinical medicine · 2025Article
- Optimized workflow for paroxysmal atrial fibrillation ablation using very high power short duration.Frontiers in cardiovascular medicine · 2025Article
- Catheter Ablation in Atrial Fibrillation: Recent Advances.Journal of clinical medicine · 2024Review
- 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.Journal of arrhythmia · 2024Article
- 2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
17 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsRadiofrequency (RF) ablation for pulmonary vein isolation (PVI) in atrial fibrillation (AF) is associated with the risk of oesophageal thermal injury (ETI). Higher power short duration (HPSD) ablation results in preferential local resistive heating over distal conductive heating. Although HPSD has become increasingly common, no randomized study has compared ETI risk with conventional lower power longer duration (LPLD) ablation. This study aims to compare HPSD vs. LPLD ablation on ETI risk. METHODS AND
resultsEighty-eight patients were randomized 1:1 to HPSD or LPLD posterior wall (PW) ablation. Posterior wall ablation was 40 W (HPSD group) or 25 W (LPLD group), with target AI (ablation index) 400/LSI (lesion size index) 4. Anterior wall ablation was 40-50 W, with a target AI 500-550/LSI 5-5.5. Endoscopy was performed on Day 1. The primary endpoint was ETI incidence. The mean age was 61 ± 9 years (31% females). The incidence of ETI (superficial ulcers n = 4) was 4.5%, with equal occurrence in HPSD and LPLD (P = 1.0). There was no difference in the median value of maximal oesophageal temperature (HPSD 38.6°C vs. LPLD 38.7°C, P = 0.43), or the median number of lesions per patient with temperature rise above 39°C (HPSD 1.5 vs. LPLD 2, P = 0.93). Radiofrequency ablation time (23.8 vs. 29.7 min, P < 0.01), PVI duration (46.5 vs. 59 min, P = 0.01), and procedure duration (133 vs. 150 min, P = 0.05) were reduced in HPSD. After a median follow-up of 12 months, AF recurrence was lower in HPSD (15.9% vs. LPLD 34.1%; hazard ratio 0.42, log-rank P = 0.04).
conclusionHigher power short duration ablation was associated with similarly low rates of ETI and shorter total/PVI RF ablation times when compared with LPLD ablation. Higher power short duration ablation is a safe and efficacious approach to PVI.
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