{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T11:25:51Z","timestamp":1758281151285,"version":"3.44.0"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The ablation index (AI) standardizes lesions in radiofreqency ablation (RF) of atrial fibrillation (AF). High\u2010power, short\u2010duration ablation (HPSD) shortens procedures, but AI is histologically unvalidated in HPSD. We evaluated esophageal safety with voltage\u2010adapted AF ablation using an optimized, AI\u2010guided HPSD (AI\u2010HPSD) protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive AF patients undergoing AI\u2010HPSD at 50\u2009W (AI\u2009=\u2009400\u2013450 for posterior left atrium (LA); AI\u2009\u2265\u2009500 anteriorly) were compared with a recent AF cohort treated by AI\u2010guided low\u2010power, long\u2010duration ablation (AI\u2010LPLD). Esophageal endoscopy was performed 1\u20133 days postablation. Posterior wall lesion characteristics and endoscopically\u2010detected esophageal lesions (EDEL) were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>AI\u2010LPLD (<jats:italic>n<\/jats:italic>\u2009=\u2009100) and AI\u2010HPSD (<jats:italic>n<\/jats:italic>\u2009=\u2009100) groups had similar baselines, except AI\u2010LPLD had slightly larger LA\u2010area. VISITAG numbers were comparable, but total posterior wall RF time was shorter with AI\u2010HPSD versus AI\u2010LPLD [4.1 (2.1\u201312.7) vs. 10.9 (5.1\u201326.6), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]. Mean AI and mean impedance drop were higher in AI\u2010HPSD [449 (394\u2013487) vs. 399 (329\u2013485), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 and 8.7 (3.9\u201315.7) vs. 7.4 (3.6\u201318.2), <jats:italic>p<\/jats:italic>\u2009=\u20090.004]. AI standard deviation was lower with AI\u2010HPSD [25 (9\u201379) vs. 48 (19\u2013100), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001]. Although Max AI values were higher in AI\u2010HPSD [514 (435\u2013662) vs. 492 (404\u2010644), <jats:italic>p<\/jats:italic>\u2009=\u20090.003), maximum impedance drop did not differ significantly. EDEL rate was comparably low at 2% (AI\u2010HPSD) and 4% (AI\u2010LPLD), but AI\u2009&gt;\u2009520 occurred more with AI\u2010HPSD (3.5\u2009\u00b1\u20095.5% vs. 2.5\u2009\u00b1\u20095.2%; <jats:italic>p<\/jats:italic>\u2009=\u20090.048).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Optimized AI\u2010HPSD at 50\u2009W with posterior LA target AI\u2009=\u2009400\u2013450 was not associated with more EDEL. However, a signal for more unacceptable Max AI values existed. We recommend limiting AI to 400 and developing an automatic, AI\u2010guided ablation stop.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16793","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T12:32:17Z","timestamp":1752064337000},"page":"2245-2253","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Posterior Wall Ablation Characteristics and Esophageal Safety of an Optimized Protocol for Voltage\u2010Guided, High\u2010Power Short\u2010Duration Ablation of Atrial Fibrillation"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6534-1629","authenticated-orcid":false,"given":"Lisa C.","family":"Costello\u2010Boerrigter","sequence":"first","affiliation":[{"name":"Department of Cardiology, Heart Center Zentralklinik Bad Berka and Clinical Research Bad Berka 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der Health and Medical University Erfurt Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens Martin","family":"Kittner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 2 Helios Hospital Erfurt Erfurt Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anja","family":"Schade","sequence":"additional","affiliation":[{"name":"Department of Cardiology\/Interventional Electrophysiology, Helios Hospital Erfurt Universit\u00e4rer Campus der Health and Medical University Erfurt Germany"},{"name":"Clinic for Rhythmology and Interventional Electrophysiology, Rh\u00f6n Campus Bad Neustadt Bad Neustadt\/Saale 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