A High Threshold of Biotherapeutic Aggregate Numbers is Needed to Induce an Immunogenic Response In Vitro, In Vivo, and in the Clinic

BACKGROUND AND PURPOSE

There is concern that subvisible aggregates in biotherapeutic drug products pose a risk to patient safety. We investigated the threshold of biotherapeutic aggregates needed to induce immunogenic responses.

METHODS AND RESULTS

Highly aggregated samples were tested in cell-based assays and induced cellular responses in a manner that depended on the number of particles. The threshold of immune activation varied by disease state (cancer, rheumatoid arthritis, allergy), concomitant therapies, and particle number. Compared to healthy donors, disease state patients showed an equal or lower response at the late phase (7 days), suggesting they may not have a higher risk of responding to aggregates. Xeno-het mice were used to assess the threshold of immune activation in vivo. Although highly aggregated samples (~ 1,600,000 particles/mL) induced a weak and transient immunogenic response in mice, a 100-fold dilution of this sample (~ 16,000 particles/mL) did not induce immunogenicity. To confirm this result, subvisible particles (up to ~ 18,000 particles/mL, containing aggregates and silicone oil droplets) produced under representative administration practices (created upon infusion of a drug product through an IV catheter) did not induce a response in cell-based assays or appear to increase the rate of adverse events or immunogenicity during phase 3 clinical trials.

CONCLUSION

The ability of biotherapeutic aggregates to elicit an immune response in vitro, in vivo, and in the clinic depends on high numbers of particles. This suggests that there is a high threshold for aggregates to induce an immunogenic response which is well beyond that seen in standard biotherapeutic drug products.

Silver-decorated SrTiO3 nanoparticles for high-performance supercapacitors and effective remediation of hazardous pollutants

SrTiO3/Ag nanocomposites were synthesized using a facile wet impregnation method, employing rigorous experimental techniques for comprehensive characterization. XRD, FTIR, UV, PL, FESEM, and HRTEM were meticulously utilized to elucidate their structural, functional, morphological, and optical properties. The electrochemical performance of the SrTiO3/Ag nanocomposite was rigorously assessed, revealing an impressive specific capacitance of 850 F/g at a current density of 1 A. Furthermore, the photocatalytic activity of the SrTiO3/Ag nanocomposite was rigorously examined using methylene blue (MB) dye, and the results were outstanding. After 120 min of UV irradiation, the nanocomposite exhibited an exceptional MB dye degradation efficiency exceeding 88%. The SrTiO3/Ag nanocomposite represents an exemplary catalyst in terms of efficiency, cost-effectiveness, environmental compatibility, and reusability. The electron and superoxide radicals play a chief role in the MB dye degradation process. The inclusion of Ag within the SrTiO3 matrix facilitated the formation of a conductive nano-network, ultimately resulting in superior capacitive and photocatalytic performance.

Large-scale computational screening of Indian medicinal plants reveals Cassia angustifolia to be a potentially anti-diabetic

Researchers are investigating the medicinal properties of herbal plants throughout the world, which often leads to the discovery of novel plants and their chemicals for prophylactic needs of humans. Natural phytochemicals continue to be sought as alternative treatments for various diseases because of their non-toxic and therapeutic properties. In recent years, computational phytochemistry has enabled large-scale screening of phytochemicals, enabling researchers to pursue a wide range of therapeutic research alternatives to traditional ethnopharmacology. We propose to identify an anti-diabetic plant by computational screening on Indian herbal plants in conjunction with experimental characterization and biological validation. The methodology involves the creation of an in-house Indian herbal plant database. Molecular docking is used to screen against alpha amylase for anti-diabetic prophylaxis. Cassia angustifolia was chosen because its phytochemicals are able to bind to alpha amylase. Plants were experimentally extracted, botanically studied and their biological activity was evaluated. Further, the use of molecular dynamics was then applied to pinpoint the phytochemicals responsible for the affinity of alpha amylase. Results in the phytochemical analysis of the extracts revealed strong presence of alkaloids, flavonoids and cardiac glycosides. Moreover, alpha amylase biological activity with C. angustifolia extracts of chloroform, hexane and ethyl acetate demonstrated activity of 3.26, 8.01 and 30.33 µg/ml validating computational predictions. In conclusion, this study developed, validated computational predictions of identifying potential anti-diabetic plants 'Cassia angustifolia' from house herbal databases. Hope this study shall inspire explore plant therapeutic repurposing using computational methods of drug discovery.Communicated by Ramaswamy H. Sarma.

Data-driven discovery of sparse dynamical model of cardiovascular system for model predictive control

Cardiovascular diseases remain the leading cause of death globally. In recent years, vagal nerve stimulation (VNS) has shown promising results in the treatment of a number of cardiovascular diseases. In this approach, mild electrical pulses are sent to the brain via the vagus nerve. This open-loop neurostimulation, however, leads to various side effects due to physiological and inter-patient variability and therefore a closed-loop delivery strategy of electrical pulses that accounts for this variability is desired. In this context, we envision data-driven sparse dynamical model parameterized by patient-specific data as appropriate for use in closed loop controller design. In this work, we build a dynamical model for mean arterial pressure and heart rate using the method sparse identification of nonlinear dynamics (SINDy). As a proxy for real datasets or measurements from a patient, we simulate a mechanistic model from the literature and then discover a data-driven model for predicting mean arterial pressure and heart rate in response to neural stimulus. This discovered model is then used to design a controller to be implemented in closed-loop via model predictive control. We observe that this data-driven model is interpretable, consistent with experiments, provides insights on the sensitivity of different stimulation locations and simplifies the formulation of the optimal control problem. Noting the set-point tracking performance of this closed-loop model-based controller that uses this discovered model, we conclude that the model is adequate in capturing the dynamics of a highly nonlinear cardiovascular system for the purpose of optimal predictive controller design.

MD Anderson Phase III Randomized Preoperative Stereotactic Radiosurgery (SRS) vs. Postoperative SRS for Brain Metastases Trial

PURPOSE/OBJECTIVE(S)

Postoperative stereotactic radiation therapy/radiosurgery (SRT/SRS) is being evaluated in comparison to Preoperative SRT for brain metastases (mets) in a limited number of prospective clinical trials. Our objective is to address the significant knowledge gap concerning the logistics of preoperative SRT in comparison to postoperative SRT in a randomized controlled study.

MATERIALS/METHODS

Patients with brain mets with at least 1 surgically operable met were randomized (1:1) to Preop vs Postop SRT. In this abstract, we present non-primary endpoint data on the trial concept and logistics of treatment for this data safety monitoring board reviewed study. Patients enrolled had 1-2 lesions resected and <15 lesions treated at time of SRT to best reflect the standard population that receive SRT and surgery at our institution.

RESULTS

From 12/2018 to 12/2022, 99 patients with 1-2 operable brain mets were enrolled and randomized to Preop (n = 49) or Postop (n = 50) SRT. Males represented 56% of the cohort compared to females, and <25% were age 18-49 years, while 27%, 29, and 19% respectively were 50-59, 60-69, and > = 70. The most frequent histologies enrolled were lung (29%), renal cell (15%), melanoma (14%), and breast (11%) cancers. The majority of patients (83%) had 1-4 brain mets on their baseline MRI and 91% subsequently had a single lesion resected. Seventy-nine patients completed both SRT and surgery, while 9% received no therapy due to drop out before study therapy initiation. Among patients receiving both therapies in the combined cohort, 68% received a non-invasive stereotactic radiosurgery instrument to the randomized cavity lesion compared to 32% receiving LINAC based SRT. Treatment of the lesion or cavity with single fraction SRT was 51% in the Preop arm vs 31% in the Postop arm. Multi-fraction (3-5 SRT) was 67% in the Postop cohort in contrast to 47% in the Preop cohort. Time from randomization to RT was 5.6 days and 33.7 days in the Preop and Postop cohorts respectively, and for surgery was 10.2 days vs 12.9 days in the Postop vs Preop cohorts. The average time from RT to surgery was 7.3 days in the Preop arm and 23.5 days in the Postop arm (to allow for incisional healing time).

CONCLUSION

In one of the early initiated randomized prospective cohorts of Preop vs Postop SRT, we demonstrated logistical feasibility with an efficient clinical trial workflow for study treatment. Differences in Preop vs Postop logistics reflect clinical practice differences in time-to-treatment. Therapy with various modalities reflected real-world practice and possibly provider preferences in technique when addressing the nature of delineating cavities and changes in cavity volume with regard to fractionation. Independent of the primary outcomes, our data provides insights in the practical management of patients receiving these two modalities of therapy, and further data at the completion of trial will address relevant primary outcomes.

Computational Analysis of Some More Rectangular Tessellations of Kekulenes and Their Molecular Characterizations

Cycloarene molecules are benzene-ring-based polycyclic aromatic hydrocarbons that have been fused in a circular manner and are surrounded by carbon-hydrogen bonds that point inward. Due to their magnetic, geometric, and electronic characteristics and superaromaticity, these polycyclic aromatics have received attention in a number of studies. The kekulene molecule is a cyclically organized benzene ring in the shape of a doughnut and is the very first example of such a conjugated macrocyclic compound. Due to its structural characteristics and molecular characterizations, it serves as a great model for theoretical research involving the investigation of π electron conjugation circuits. Therefore, in order to unravel their novel electrical and molecular characteristics and foresee potential applications, the characterization of such components is crucial. In our current research, we describe two unique series of enormous polycyclic molecules made from the extensively studied base kekulene molecule, utilizing the essential graph-theoretical tools to identify their structural characterization via topological quantities. Rectangular kekulene Type-I and rectangular kekulene Type-II structures were obtained from base kekulene molecules arranged in a rectangular fashion. We also employ two subcases for each Type and, for all of these, we derived ten topological indices. We can investigate the physiochemical characteristics of rectangular kekulenes using these topological indices.

Quantitative measurement of the requirement of diverse protein degradation pathways in MHC class I peptide presentation

Peptides from degradation of intracellular proteins are continuously displayed by major histocompatibility complex (MHC) class I. To better understand origins of these peptides, we performed a comprehensive census of the class I peptide repertoire in the presence and absence of ubiquitin-proteasome system (UPS) activity upon developing optimized methodology to enrich for and quantify these peptides. Whereas most class I peptides are dependent on the UPS for their generation, a surprising 30%, enriched in peptides of mitochondrial origin, appears independent of the UPS. A further ~10% of peptides were found to be dependent on the proteasome but independent of ubiquitination for their generation. Notably, clinically achievable partial inhibition of the proteasome resulted in display of atypical peptides. Our results suggest that generation of MHC class I•peptide complexes is more complex than previously recognized, with UPS-dependent and UPS-independent components; paradoxically, alternative protein degradation pathways also generate class I peptides when canonical pathways are impaired.

Development and validation of the HARMS2-AF lifestyle risk score to predict incident AF

Background

Lifestyle risk factors (RFs) are a modifiable target in atrial fibrillation (AF) management. However, the relative contribution of individual lifestyle RFs to AF incidence has not been described.

Purpose

Development and validation of a novel AF-lifestyle risk score to determine AF risk in the general population.

Methods

The UK Biobank (UKB) is a large prospective cohort with outcomes measured &gt;10 years. In the UKB, we performed regression analysis of AF lifestyle RFs which were then evaluated in a multivariable model and a weighted score was developed. Next, the risk score was externally validated in the Framingham Heart Study (FHS) population. Kaplan-Meier estimates ascertained the 10-year risk of AF development.

Results

In the UKB, AF incidence was 5.3% among 302,926 participants, with a median time to AF 7.3 years (IQR 4.3–9.8). Hypertension, sleep apnoea, male sex, age, obesity (BMI&gt;30 kg/m2), alcohol and smoking were predictive variables (all p&lt;0.001); physical inactivity (OR 1.02,95% CI 0.97–1.10, p=0.3), diabetes (OR 0.98,95% CI 0.91–1.06, p=0.2) and BMI 27–30 kg/m2 (OR 1.02, 95% CI 0.97–1.07, p=0.424) were not significant. The HARMS2-AF score (Figure 1) had similar predictive performance (AUC=0.782, LogLoss 0.178, Brier Score 0.046) to the unweighted regression model (AUC 0.808) in the UKB. Validation in the FHS (AF incidence 6.7% of 7206 participants) maintained excellent predictive performance with an AUC of 0.747 (95% CI 0.724–0.769, Figure 2). A higher HARMS2-AF score (&gt;5 points) was associated with a heightened 10-year AF risk (score 5–9: OR 9.35, score 10–14: OR 33.34).

Conclusions

The HARMS2-AF score is a novel lifestyle risk score which may help identify individuals at risk of AF and assists in general population screening.

Funding Acknowledgement

Type of funding sources: None.

Catheter ablation in atrial fibrillation and heart failure with preserved ejection fraction improves peak pulmonary capillary wedge pressure, exercise capacity and quality of life: RCT STALL HFpEF

Introduction

Atrial fibrillation (AF) frequently accompanies heart failure with preserved ejection fraction (HFpEF). AF exacerbates HFpEF through adverse haemodynamic effects. In turn, HFpEF promotes AF through adverse left atrial remodelling. Observational data suggest sinus rhythm restoration improves outcomes in patients with AF and HFpEF. However, there are no randomised data examining the effects of rhythm control with catheter-based AF ablation on HFpEF outcomes.

Purpose

To compare the effects of AF ablation versus usual medical therapy on markers of HFpEF severity, including exercise haemodynamics, natriuretic peptide levels and patient symptoms.

Methods

Patients with symptomatic AF and HFpEF underwent exercise right heart catheterization (RHC) and cardiopulmonary exercise testing (CPET). HFpEF diagnosis was based on left ventricular ejection fraction (LVEF) ≥50%, elevated natriuretic peptide and echocardiographic diastolic impairment. HFpEF was confirmed on exercise RHC based on peak exercise pulmonary capillary wedge pressure (PCWP) of ≥25mmHg. Patients were randomised to AF ablation versus medical therapy, with investigations repeated at 6 months. The primary outcome was change in PCWP on follow-up.

Results

31 patients aged 66.1±7.5 years were randomized to AF ablation (16) versus medical therapy (15), with 51.6% female and 80.6% persistent AF. Baseline characteristics were comparable across groups. Paired analyses of ablation cohort showed significant reductions in peak PCWP (29.6±3.7 vs 25.9±4.6 mmHg, p&lt;0.01), PCWP indexed for workload (39.0±57.9 vs 33.0±50.5 mmHg/W/kg, p&lt;0.01), and BNP (146.2±80.5 vs 82.2±75.4 pg/mL, p=0.01); and increased resting cardiac output (4.6±0.9 vs 5.6±1.2 L/min, p=0.01), peak cardiac output (9.6±4.2 vs 10.4±3.7 L/min, p=0.02), peak (30s averaged) VO2 (1875.1±759.2 vs 2193.7±878.1 mL/min, p&lt;0.01), peak absolute VO2 (1937.3±739.3 vs 2216.3±861.9 mL/min, p&lt;0.01), peak (30s averaged) relative VO2 (19.4±5.9 vs 22.9±7.4 ml/kg/min) and peak workload (162.0±81.1 vs 184.4±83.4 W, p&lt;0.01). Quality of life scores improved: AFEQT (45.3±20.9 vs 75±20.7, p&lt;0.01) and MLHF (53±23.3 vs 17.5±22.8, p&lt;0.01). Reversal of HFpEF by PCWP criteria occurred in 31.2% following AF ablation, and 50% among those free from arrhythmia recurrence. In the medical arm, there were no significant differences in RHC, CPET, and natriuretic peptide outcomes on follow-up versus baseline. Repeated measures mixed ANOVA testing showed significant time-randomisation interaction on peak VO2, absolute peak VO2, peak relative VO2, AFEQT/ MLHF scores, suggesting that significant improvements in these parameters were related to AF ablation.

Conclusion

In patients with concomitant AF and HFpEF, AF ablation improves invasive exercise haemodynamic parameters, increases exercise capacity, and enhances quality of life. Successful AF ablation may reverse the clinical syndrome of HFpEF in a subset of cases.

Funding Acknowledgement

Type of funding sources: None.

Clinical risk prediction for left atrial appendage thrombus among patients with atrial fibrillation

Background

Exclusion of left atrial appendage thrombus (LAAT) by transoesophageal echocardiography (TOE) is recommended in patients with inadequate anticoagulation prior to direct cardioversion (DCR) or catheter ablation for atrial fibrillation/flutter (AF/AFL). LAAT risk factors in this population remain poorly defined.

Purpose

Determine LAAT predictors in AF/AFL patients undergoing pre-procedural TOE.

Methods

We evaluated available clinical and transthoracic echocardiographic (TTE) parameters in AF/AFL patients undergoing TOE between 1999–2022 in our institution in Melbourne, Australia. Regression analysis identified predictors of LAAT, which were applied to a weighted score developed in the derivation cohort (70%) and validated in the remaining 30%.

Results

Of 627 patients (age 62±12 years, 27% female, AF 84%,AFL 16%, left ventricular ejection fraction (LVEF) 44±20%), 24% had LAAT and 13.8% dense spontaneous echo contrast precluding DCR. Anticoagulation was NOAC 56.5%, warfarin 32.1% and none in 11.4%. In the LAAT cohort, thrombus resolution occurred in 39% on serial transoesophageal imaging with a median time to resolution of 131 days (IQR 54–398).

Diabetes (p=0.004), prior stroke (p=0.009), coronary disease (p=0.015), renal impairment (p&lt;0.001) and CHADS2VASc &gt;2 (73% vs. 55%, p&lt;0.001) were higher in the LAAT cohort. Age (p=0.093), gender (p=0.689), BMI (p=0.828), anticoagulant type (p=0.316) and diabetes (p=0.107) were not univariate predictors, whereas anticoagulation duration (&lt;30 days), creatinine and TTE markers of remodeling (LVEF, LAVI, RVSP and TAPSE) were independent predictors on univariate and multivariate regression; CHADS2VASc was not significant after adjustment (p=0.090). The weighted risk model included continuous (age, creatinine, LVEF, LAVI, TAPSE and RVSP) and categorical (anticoagulation duration) variables with excellent predictive performance: AUC 0.872 (95% CI 0.798–0.946), PPV 91%, NPV 70% and accuracy 80%.

Conclusion

A novel LAAT risk model comprising clinical and echocardiographic parameters enhances risk prediction over CHADS2VASc in AF/AFL and may guide the need for pre-procedural TOE imaging.

Funding Acknowledgement

Type of funding sources: None.

Resolving-power domination number of probabilistic neural networks

Power utilities must track their power networks to respond to changing demand and availability conditions to ensure effective and efficient operation. As a result, several power companies continuously employ phase measuring units (PMUs) to continuously check their power networks. Supervising an electric power system with the fewest possible measurement equipment is precisely the vertex covering graph-theoretic problems otherwise a variation of the dominating set problem, in which a set D is defined as a power dominating set (PDS) of a graph if it supervises every vertex and edge in the system with a couple of rules. If the distance vector eccentrically characterizes each node in G with respect to the nodes in R, then the subset R of V (G) is a resolving set of G. The problem of finding power dominating set and resolving set problems are proven to be NP-complete in general. The finite subset R of V (G) is said to be resolving-power dominating set (RPDS) if it is both resolving and power dominating set, which is another NP-complete problem. The ηp (G) is the minimal cardinality of an RPDS of a graph G. A neural network is a collection of algorithms that tries to figure out the underlying correlations in a set of data by employing a method that replicates how the human brain functions. Various neural networks have seen rapid progress in multiple fields of study during the last few decades, including neurochemistry, artificial intelligence, automatic control, and informational sciences. Probabilistic neural networks (PNNs) offer a scalable alternative to traditional back-propagation neural networks in classification and pattern recognition applications. They do not necessitate the massive forward and backward calculations that ordinary neural networks entail. This paper investigates the resolving-power domination number of probabilistic neural networks.

Anti-dengue Potential of Mangiferin: Intricate Network of Dengue to Human Genes

Dengue fever has become one of the deadliest infectious diseases and requires the development of effective antiviral therapies. It is caused by members of the Flaviviridae family, which also cause various infections in humans, including dengue fever, tick-borne encephalitis, West Nile fever, and yellow fever. In addition, since 2019, dengue-endemic regions have been grappling with the public health and socio-economic impact of the ongoing coronavirus disease 19. Co-infections of coronavirus and dengue fever cause serious health complications for people who also have difficulty managing them. To identify the potentials of mangiferin, a molecular docking with various dengue virus proteins was performed. In addition, to understand the gene interactions between human and dengue genes, Cytoscape was used in this research. The Kyoto Encyclopedia of Genes and Genomes software was used to find the paths of Flaviviridae. The Kyoto Encyclopedia of Genes and Genomes and the Reactome Pathway Library were used to understand the biochemical processes involved. The present results show that mangiferin shows efficient docking scores and that it has good binding affinities with all docked proteins. The exact biological functions of type I interferon, such as interferon-α and interferon-β, were also shown in detail through the enrichment analysis of the signaling pathway. According to the docking results, it was concluded that mangiferin could be an effective drug against the complications of dengue virus 1, dengue virus 3, and non-structural protein 5. In addition, computational biological studies lead to the discovery of a new antiviral bioactive molecule and also to a deeper understanding of viral replication in the human body. Ultimately, the current research will be an important resource for those looking to use mangiferin as an anti-dengue drug.

Enhanced photocatalytic activity of ZnO hexagonal tube/r-GO composite on degradation of organic aqueous pollutant and study of charge transport properties

ZnO hexagonal tube and ZnO/r-GO nanocomposites were synthesized by hydrothermal method and the nanostructures were characterized by XRD, UV-DRS, PL, FTIR, FESEM, and TEM techniques. The main violet emission peak of the synthesized nanostructures is due to the transition between interstitial zinc and hole (valence band) of ZnO. The potential of ZnO/r-GO nanocomposite was evaluated using methyl orange (MO) and rhodamine-B (RhB), and the results were compared with the activity of synthesized ZnO nanostructures. More than 95% of MO and RhB were by ZnO/r-GO nanocomposite and it was found to be higher than that of ZnO hexagonal tube. The degradation MO and RhB were found to follow first-order kinetics and it has a rate constant of 7.68 × 10^-2and 7.83 × 10^-2 min^-1, respectively. These results are mainly due to the enhanced charge transport property. Trapping experiments show that superoxide radical anion and hydroxide radicals are chief species responsible for the degradation of MO and RhB. The chemical stability of the nanocomposite was evaluated by cycle test experiments and it reveals that the catalyst can be reused up to few cycles without considerable loss of photocatalytic activity. This work affords a simple stratagem to integrate ZnO hexagonal tubes and r-GO nanosheets to construct effective catalysts for the degradation of organic compounds.

High power short duration (HPSD) versus lower power longer duration (LPLD) atrial fibrillation ablation: a multi-centre randomised controlled trial (HiLo-HEAT study)

Funding Acknowledgements

Type of funding sources: None.

Background

 Lower power (25W) longer duration (LPLD) radiofrequency (RF) ablation has conventionally been used on the posterior wall during pulmonary vein isolation (PVI) for atrial fibrillation (AF), to attenuate the risk of esophageal thermal injury (ETI). High power (40-50 W) short duration (HPSD) RF ablation results in shorter procedural times with no increase in ETI. However evidence had been limited by non-randomised studies.

Purpose

 To compare HPSD versus LPLD ablation and the effects on esophageal thermal injury (ETI) and procedural outcomes.

Methods

 In this multi-centre, prospective, randomised control trial, 88 patients with paroxysmal/persistent AF undergoing their first RF ablation procedure were randomised 1:1 to HPSD or LPLD ablation. Anterior wall ablation was done in both arms using 40-50 W, with ablation target of AI 500-500/ LSI 5-5.5. Posterior wall ablation was done using 40-50W (HPSD group) versus 25 W (LPLD group), with target AI 400/ LSI 4. Ablation involves wide antral circumferential PVI using contact force sensing ablation catheters, with additional ablation lines as per operator discretion. Circa multi-sensor esophageal temperature monitoring (ETM) probe was utilized. Endoscopy was performed within 24 hours to assess for ETI. The primary outcome was incidence of ETI, with secondary outcomes including acute procedural endpoints.

Results

 Mean age of the cohort was 61+/-9 years, with 31% females. 36 (41%) had PAF. PVI was achieved in 100% of patients, with posterior wall isolation (PWI) added in 19 PsAF patients (21.6%). There were more hypertensive patients in HPSD (p = 0.02). Significant esophageal luminal temperature rises (≥ 38 c) were seen in 93.2% of patients, with no difference between groups (p = 0.69). First pass isolation rates for left and right PVs were 85% and 61% respectively, with similar rates in both groups (p = 0.37, p = 0.65 respectively). HPSD group had shorter RF time (1613 vs 2303 secs, p &lt;0.04), and fluoroscopy times (11.4 vs 13.1 mins, p = 0.05). Procedural times were lower in HPSD, although not significant (133.7 vs 150.8 mins, p = 0.10). Post ablation endoscopy showed 4 cases of ETI (4.5%), with equal occurrence in HPSD and LPLD (p = 1.0). All ETIs were class 2a (superficial ulcer), and treated with PPI therapy. Esophageal injuries not attributable to RF ablation occurred in 9 (10%), with no difference between groups (p = 0.29). There was no difference in AF recurrence between the 2 groups (post 3 months blanking period) after a mean follow up of 6.3 months (p = 0.71).

Conclusion

 HPSD ablation was associated with lower RF ablation and fluoroscopy times compared to LPSD, with comparably low rates of ETI on post ablation endoscopy. Our findings suggest that HPSD ablation is a safe and efficacious approach to PVI. However clinicians should be cognisant of the potential injury risk related to esophageal instrumentation from transesophageal echo/ ETM probes.