Objectives: The goal of this study was to compare lesion durability between high-power short-duration (HP-SD) and moderate-power moderate-duration (MP-MD) ablation strategies.
Background: HP-SD radiofrequency ablation (RFA) was developed to improve pulmonary vein isolation (PVI) by reducing the effect of catheter instability inherent to MP-MD ablation strategies. However, its long-term effect on lesion durability for the treatment of atrial fibrillation is unknown.
Methods: Patients with atrial fibrillation (n = 112) underwent PVI using HP-SD ablation (45 to 50 W, 8 to 15 s) with contact force-sensing open irrigated catheter. Cavotricuspid isthmus, mitral annular, and roof lines were permitted. A control group (n = 112) underwent ablation using MP-MD ablation (20 to 40 W, 20 to 30 s) with similar technology. Chronic PV reconnection was examined in patients who required a redo procedure (HP-SD ablation, n = 18; MP-MD ablation, n = 23).
Results: The rate of PVI at the completion of the initial encirclement was similar between the HP-SD and MP-MD ablation strategies (90.2% vs. 83.0%; p = 0.006). The HP-SD strategy required shorter RFA time (17.2 ± 3.4 min vs. 31.1 ± 5.6 min; p < 0.001). The incidence of chronic PV reconnection was lower with HP-SD ablation (16.6% vs. 52.2%; p = 0.03). Areas of chronic reconnection were associated with catheter motion ≥1 mm for ≥50% application duration. In a higher proportion of HP-SD applications, catheter motion was <1 mm during ≥50% duration (88.6% vs. 72.8%; p < 0.001), allowing energy delivery with greater stability. Both ablation strategies were effective for cavotricuspid isthmus; however, the HP-SD strategy was less effective for mitral annular lines, requiring ablation at lower power for longer duration to avoid steam pops.
Conclusions: HP-SD ablation may improve PVI durability, and it shortens RFA time. However, ablation in thicker myocardium often requires lower power applied for longer duration, allowing deeper lesions without tissue overheating.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.jacep.2020.04.023 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Impact of High-Power Short-Duration Radiofrequency Ablation on Esophageal Temperature Dynamic.
Circ Arrhythm Electrophysiol
November 2021
Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, OH (H.D.Y., K.H., J.S., M.K., D.C., W.I.S., K.G.T., A.A.H., O.W., E.A.).
Article Synopsis
- High-power short-duration (HP-SD) radiofrequency ablation (RFA) was studied to assess its effectiveness and safety compared to moderate-power moderate-duration (MP-MD) RFA for isolating pulmonary veins and reducing esophageal injury risk.
- The study measured esophageal temperature changes and injury in 20 patients and 6 swine by applying HP-SD and MP-MD in alternating sequences, using a multisensor probe for precise temperature tracking.
- Results showed similar temperature dynamics and levels of esophageal tissue injury between HP-SD and MP-MD RFA, indicating both methods may have comparable safety profiles.
Impact of High-Power Short-Duration Radiofrequency Ablation on Long-Term Lesion Durability for Atrial Fibrillation Ablation.
JACC Clin Electrophysiol
August 2020
Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address:
Objectives: The goal of this study was to compare lesion durability between high-power short-duration (HP-SD) and moderate-power moderate-duration (MP-MD) ablation strategies.
Background: HP-SD radiofrequency ablation (RFA) was developed to improve pulmonary vein isolation (PVI) by reducing the effect of catheter instability inherent to MP-MD ablation strategies. However, its long-term effect on lesion durability for the treatment of atrial fibrillation is unknown.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!