Ablation Index‐guided high‐power (50 W) short‐duration for left atrial anterior and roofline ablation: Feasibility, procedural data, and lesion analysis (AI High‐Power Linear Ablation)

Abstract

Objectives To evaluate the feasibility, procedural data, and lesion characteristics of the anterior line (AL) and roofline (RL) ablation by using ablation index (AI)‐guided high power (50 W) among patients with recurrent atrial fibrillation (AF) or atrial tachycardia (AT) after pulmonary vein isolation (PVI). Methods Data from 35 consecutive patients with macro‐reentrant left atrial tachycardia or substrate at the left atrium anterior wall or roof after previous PVI were collected. Ablation power was set to 50 W, targeting AI 500 for AL and 400 for RL. The first‐pass conduction block (FPB) was evaluated. The AL was arbitrarily divided into three (caudal, middle, and cranial) segments to analyze the location of conduction gaps in non‐FPB patients. Results A total of 32 AL and 17 RL were deployed and FPB was achieved in 24 (75%) and 14 (82%) of them, respectively. In the non‐FPB group, the most frequent gap location along the AL was the middle third. The final block of AL was achieved in 97%, and the block of RL was achieved in 100%. The radiofrequency (RF) ablation time was short (2.9 ± 0.8 min for AL and 46.2 ± 15.6 s for RL). For AL, the female gender was significantly more frequent in FPB than in non‐FPB patients (p = .028); patients with non‐FPB were associated with significantly longer RF time as compared to patients with FPB (204 ± 47 s vs. 161 ± 41 s; p = .02). No procedural complications occurred. Conclusion AI‐guided high‐power (50 W) ablation appears to be a feasible, effective, and fast technique for AL and RL ablation.

Optimal Ablation Settings Predicting Durable Scar Detected Using LGE-MRI after Modified Left Atrial Anterior Line Ablation

“…At present, there is no consensus in definition for what constitutes HPSD ablation, which varied from 50 to 90 W. This variation is also reflected in lesion geometry [27]. Even if the focus of the recent study from Zanchi et al centred on acute ablation success, and the difference of the power setting was lower compared with our study, they could still show that AI-guided high-power (50 W) ablation, targeting AI 500, seems to be a feasible technique with high first pass block rate for anterior line ablation [28]. However, AI is not validated for HPSD and more clinical data are required for line ablation with HPSD, especially with regard to long-term results.…”

Esophageal temperature during atrial fibrillation ablation poorly predicts esophageal injury: An observational study

“… 5 Feasibility and safety of the HSPD procedure has been previously demonstrated in several studies. 16 A study that included over 10,000 patients (Winkle and colleagues 2 ) showed that HPSD ablations had lower complication rates and shorter procedural times compared to other conventional methods. Leshem and colleagues 17 echoed this finding by demonstrating that HSPD actually improved lesion-to-lesion uniformity, linear contiguity, and transmurality compared to conventional ablation while maintaining a similar safety profile.…”

“…It also results in less collateral damage to extra-cardiac structures due to reduced resistive heating (16). Feasibility and safety of the HSPD procedure has been previously demonstrated in several studies (17). In a study that included over 10,000 patients (Winkle et al), it showed that HPSD ablations had lower complication rates and shorter procedural times compared to other conventional methods (18).…”

Treatment of Macro-Reentry Atrial Tachycardia with Very High-Power, Short-Duration, Temperature-Controlled Ablation of Anterior Line Using an Open-Irrigated Ablation Catheter with Microelectrodes

“…In a previous study, HP-SD artificial intelligence-guided ablation at a maximum of 50 W was evaluated [ 2 ]. The technique seemed to be safe and effective, but no real-time temperature surveillance was possible with conventional CF sensing catheters.…”

“…Catheter ablation has proven to be a very successful procedure for patients with atrial fibrillation (AF), with excellent outcomes on long-term follow-up. Recently, a radiofrequency (RF)-based, power-controlled ablation mode called high-power, short-duration (HP-SD) has been introduced that delivers a maximum of 50 W for treatment with pulmonary vein isolation (PVI) and deployment of linear lesions [ 1 , 2 ] With HP-SD, the length of the procedure and RF time are shorter and rates of isolation on the first past are increased, compared with standard RF ablation [ 1 ].…”