Validity and safety of HP strategy
Recent clinical studies revealed the efficacy and safety of HPSD-PVI
over conventional PVI at normal power and
duration,[8-10] where RF time and energy could be
reduced.[2, 3] The result shown here concurred
with that of previous reports with total RF time of 10 min and RF energy
of 29 kJ for PVI.[2, 11]
Theoretically, HPSD-PVI could lessen collateral damage with a shallow
and wide lesion creation due to resistive
heating.[12, 13] Clinically, Winkle et al have
recently demonstrated the extremely low complication rate using
HPSD-PVI, where a smaller number of atrio-esophageal fistula was
observed compared to the conventional
strategy.[14] Similarly, by assessing esophageal
thermal injury after HPSD-PVI by late gadolinium enhancement magnetic
resonance imaging within 24 hours post-procedure, Baher et al concluded
that the distribution and severity of esophageal damage was similar
between HPSD-PVI and low power long duration
groups.[15] These data highlighted the safeness of
HPSD-PVI over conventional strategy. In the present study, only 1
patient with an enlarged LA had experienced acute right phrenic nerve
injury after right-sided PVI, although this partially recovered within
half a year. Subsequently, a 10-mA stimulation test was routinely
performed at the right superior PV antrum to avoid phrenic nerve injury.
In patients with breathing disorder, deep sedation could hinder HPSD-PVI
due to unstable catheter contact. Therefore, moderate anesthesia with
dexmedetomidine could keep optimal condition without evoking breathing
disorder in such cases. Similarly, controlled tidal volume using
mechanical ventilator could allow for HPSD-PVI even in patients under
general anesthesia.