{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T17:34:14Z","timestamp":1791135254654,"version":"4.1.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2010,6]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>High-intensity focused ultrasound (HIFU) can achieve pulmonary vein isolation (PVI), but there are safety concerns after severe complications. Therefore, we evaluated an esophageal temperature (ET)-guided safety algorithm to apply HIFU safely.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              After standard left atrial access, HIFU was repeatedly applied until PVI was complete. A safety algorithm was used: \u22643 complete ablations per pulmonary vein (PV), early abortion when no effect after 50%of programmed time or when ET was \u226540.0\u00b0C, use of power modulation (PM) at ET 39.0\u00b0C: to reduce ablation temperature in surrounding tissue, acoustic power is switched on\/off at 1 Hz; in all first ablations, use of PM after 50% of programmed time. Touch-up radiofrequency ablation was used when PVI failed. Periprocedural ET monitoring and endoscopy 2 days after ablation were performed. Twenty-eight patients (18 males; mean age at enrollment, 63 years), with paroxysmal atrial fibrillation (AF; n=19) and persistent AF (n=9) were included. In 84 of 109 PV (9 of 25 patients), PVI was achieved using HIFU only. In 9 of 109 PV, HIFU was aborted because of high ET. Mean ET at the end of the ablations with and without use of PM were 38.1\u00b12.0\u00b0C and 37.4\u00b11.0\u00b0C (\n              <jats:italic>P<\/jats:italic>\n              =0.0002). During endoscopy in 2 of 26 patients, a small thermal lesion was found. Other complications included 2 persistent phrenic nerve palsies, 1 ischemic stroke, 1 pericardial effusion 48 days after ablation, 1 unexplained death 49 days after ablation, and 1 lethal atrial-to-esophageal fistula 31 days after ablation.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>The safety algorithm failed to prevent lethal complications. Currently HIFU does not meet the safety standards required for treatment of atrial fibrillation.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.109.922930","type":"journal-article","created":{"date-parts":[[2010,5,27]],"date-time":"2010-05-27T02:15:56Z","timestamp":1274926556000},"page":"260-265","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":112,"title":["Fatal End of a Safety Algorithm for Pulmonary Vein Isolation With Use of High-Intensity Focused Ultrasound"],"prefix":"10.1161","volume":"3","author":[{"given":"Kars","family":"Neven","sequence":"first","affiliation":[{"name":"From the Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"Schmidt","sequence":"additional","affiliation":[{"name":"From the Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Metzner","sequence":"additional","affiliation":[{"name":"From the Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyoshi","family":"Otomo","sequence":"additional","affiliation":[{"name":"From the Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter","family":"Nuyens","sequence":"additional","affiliation":[{"name":"From the Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"De Potter","sequence":"additional","affiliation":[{"name":"From the Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.R. Julian","family":"Chun","sequence":"additional","affiliation":[{"name":"From the Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feifan","family":"Ouyang","sequence":"additional","affiliation":[{"name":"From the Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Heinz","family":"Kuck","sequence":"additional","affiliation":[{"name":"From the Asklepios Klinik St Georg, Department of Cardiology, Hamburg, Germany."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2007.04.005"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2007.01.017"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2008.05.003"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2007.08.023"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/eup208"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000157153.30978.67"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm227"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2006.00589.x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2009.01495.x"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000131866.44650.46"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2005.00333.x"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2005.02.738"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/circep.108.789552"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2008.01130.x"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540-8167.2007.00790.x"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/circep.108.807925"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/circep.108.805366"}],"container-title":["Circulation: Arrhythmia and Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCEP.109.922930","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:18:52Z","timestamp":1715559532000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCEP.109.922930"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,6]]},"references-count":17,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2010,6]]}},"alternative-id":["10.1161\/CIRCEP.109.922930"],"URL":"https:\/\/doi.org\/10.1161\/circep.109.922930","relation":{},"ISSN":["1941-3149","1941-3084"],"issn-type":[{"value":"1941-3149","type":"print"},{"value":"1941-3084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,6]]},"assertion":[{"value":"2009-11-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2010-04-17","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2010-05-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}