{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:48:00Z","timestamp":1792039680990,"version":"4.4.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Esophageal mucosal injury and gastroparesis are clinically important complications of radiofrequency ablation (RFA) of atrial fibrillation (AF). Pulsed\u2010field ablation (PFA) is a non\u2010thermal modality that may spare these complications due to its myocardial tissue selectivity.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n We aimed to compare the incidence of endoscopically detected esophageal lesions (EDELs) and suspected gastroparesis between RFA and PFA as the primary endpoints. Secondary endpoints included perioperative complications, procedural parameters, and 365\u2010day clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Between July 2023 and July 2025, patients undergoing a first\u2010time AF ablation with RFA or PFA were enrolled. RFA was performed using either a QDOT MICRO catheter (Biosense Webster, Inc., Irvine, CA, USA) or a TactiFlex Ablation Catheter, Sensor Enabled (Abbott, Abbott Park, IL, USA), while PFA was performed using the FARAPULSE system or the PulseSelect system. All patients underwent upper gastrointestinal endoscopy on the day after ablation. An EDEL was defined as esophageal erythema, erosion, ulcer, or atrio\u2010esophageal fistula. Suspected gastroparesis was defined as gastric food residue after > 12 h of overnight fasting. Clinical follow\u2010up was performed with 12\u2010lead or Holter electrocardiography.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 84 patients were included (RFA:\n n<\/jats:italic>\n = 43; PFA:\n n<\/jats:italic>\n = 41). Esophageal erosion was observed in 2 patients in the RFA group (4.7%) and in none in the PFA group (\n p<\/jats:italic>\n = 0.49). Suspected gastroparesis occurred in 15 patients treated with RFA (34.9%) and in none treated with PFA (\n P<\/jats:italic>\n <0.001). All patients were asymptomatic during endoscopy. No other procedural complications were observed in either group. The total procedure time was significantly shorter with PFA (158.5 \u00b1 40.8\u00a0vs. 193.8 \u00b1 38.3\u00a0min,\n p<\/jats:italic>\n < 0.001), while the fluoroscopy time was longer. At 365 days, atrial arrhythmia recurrence rates were comparable between the two groups (\n p<\/jats:italic>\n = 0.47).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this single\u2010center cohort, PFA was associated with a significantly lower incidence of suspected gastroparesis than RFA, and no EDELs were observed in the PFA group. PFA may reduce gastrointestinal injury associated with AF ablation. Further studies are needed to confirm these findings and clarify their clinical significance.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/pace.70472","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T04:26:02Z","timestamp":1792038362000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulsed Field Versus Radiofrequency Ablation of Atrial Fibrillation: Esophageal Lesions and Suspected Gastroparesis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8437-6111","authenticated-orcid":false,"given":"Atsushi","family":"Murakami","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4276-479X","authenticated-orcid":false,"given":"Koji","family":"Fukuzawa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"},{"name":"Section of Arrhythmia Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1768-802X","authenticated-orcid":false,"given":"Mitsuru","family":"Takami","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5906-0166","authenticated-orcid":false,"given":"Kimitake","family":"Imamura","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"},{"name":"Section of Arrhythmia Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1938-330X","authenticated-orcid":false,"given":"Hirofumi","family":"Abe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Gastroenterology Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidehiro","family":"Iwai","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0493-1034","authenticated-orcid":false,"given":"Mitsuhiko","family":"Shoda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3730-8045","authenticated-orcid":false,"given":"Shogo","family":"Yonehara","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Asada","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4071-5747","authenticated-orcid":false,"given":"Takahiro","family":"Kunigita","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Tsuboi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahito","family":"Nakano","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wako","family":"Suehiro","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken\u2010ichi","family":"Hirata","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromasa","family":"Otake","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Division of Cardiovascular Medicine Kobe University Graduate School of Medicine Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"issue":"5","key":"e_1_2_12_2_1","first-page":"373","article-title":"ESC Guidelines for the Diagnosis and Management of Atrial Fibrillation Developed in Collaboration With the European Association of Cardio\u2010Thoracic Surgery (EACTS): The Task Force for the Diagnosis and Management of Atrial Fibrillation of the European Society of Cardiology (ESC). 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With High\u2010Power (50 watts) Radiofrequency Energy","volume":"51","author":"Do U.","year":"2020","journal-title":"Korean Circulation Journal"},{"issue":"7","key":"e_1_2_12_20_1","article-title":"Progression From Esophageal Thermal Asymptomatic Lesion to Perforation Complicating Atrial Fibrillation Ablation: A Single\u2010Center Registry","volume":"10","author":"Halbfass P.","year":"2017","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"issue":"7","key":"e_1_2_12_21_1","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1093\/europace\/eux185","article-title":"Anatomical Predisposing Factors of Transmural Thermal Injury After Pulmonary Vein Isolation","volume":"20","author":"Kaneshiro T.","year":"2018","journal-title":"Europace"},{"issue":"3","key":"e_1_2_12_22_1","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1002\/joa3.13036","article-title":"Characteristics of Radiofrequency Lesions in Patients With Symptomatic Periesophageal Vagal Nerve Injury 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Radiofrequency Ablation for Atrial Fibrillation","volume":"46","author":"Shah D.","year":"2005","journal-title":"Journal of the American College of Cardiology"},{"issue":"9","key":"e_1_2_12_26_1","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1016\/j.jacc.2020.07.007","article-title":"Pulsed Field Ablation in Patients With Persistent Atrial Fibrillation","volume":"76","author":"Reddy V. 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M.","year":"2008","journal-title":"Circulation: Arrhythmia and Electrophysiology"},{"issue":"7","key":"e_1_2_12_33_1","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.hrthm.2019.01.030","article-title":"Endoscopic Evaluation of the Esophagus After Catheter Ablation of Atrial Fibrillation Using Contiguous and Optimized Radiofrequency Applications","volume":"16","author":"Wolf M.","year":"2019","journal-title":"Heart Rhythm"},{"issue":"8","key":"e_1_2_12_34_1","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.hrcr.2025.05.015","article-title":"A Case Report of Persistent Phrenic Nerve Injury by Pulsed Field Ablation: Lessons From Anatomical Reconstruction and Electrode Positioning","volume":"11","author":"Oda Y.","year":"2025","journal-title":"Heart Rhythm Case Reports"},{"issue":"23","key":"e_1_2_12_35_1","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1161\/CIRCULATIONAHA.122.061497","article-title":"Coronary Arterial Spasm During Pulsed Field Ablation to Treat Atrial Fibrillation","volume":"146","author":"Reddy V. 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