Comparison of lesion characteristics between conventional and high-power short-duration ablation using contact force-sensing catheter in patients with paroxysmal atrial fibrillation

Abstract

Background Transmural lesion creation is essential for effective atrial fibrillation (AF) ablation. Lesion characteristics between conventional energy and high-power short-duration (HPSD) setting in contact force-guided (CF) ablation for AF remained unclear. Methods Eighty consecutive AF patients who received CF with conventional energy setting (power control: 25–30 W, force–time integral = 400 g s, n = 40) or with HPSD (power control: 40–50 W, 10 s, n = 40) ablation were analyzed. Of them, 15 patients in each conventional and HPSD group were matched by age and gender respectively for ablation lesions analysis. Type A and B lesions were defined as a lesion with and without significant voltage reduction after ablation, respectively. The anatomical distribution of these lesions and ablation outcomes among the 2 groups were analyzed. Results 1615 and 1724 ablation lesions were analyzed in the conventional and HPSD groups, respectively. HPSD group had a higher proportion of type A lesion compared to conventional group (P < 0.01). In the conventional group, most type A lesions were at the right pulmonary vein (RPV) posterior wall (50.2%) whereas in the HPSD group, most type A lesions were at the RPV anterior wall (44.0%) (P = 0.04). The procedure time and ablation time were significantly shorter in the HPSD group than that in the conventional group (91.0 ± 12.1 vs. 124 ± 14.2 min, P = 0.03; 30.7 ± 19.2 vs. 57.8 ± 21 min, P = 0.02, respectively). At a mean follow-up period of 11 ± 1.4 months, there were 13 and 7 patients with recurrence in conventional and HPSD group respectively (P = 0.03). Conclusion Optimal ablation lesion characteristics and distribution after conventional and HPSD ablation differed significantly. HPSD ablation had shorter ablation time and lower recurrence rate than did conventional ablation.

Steerable versus nonsteerable sheath technology in atrial fibrillation ablation: A systematic review and meta‐analysis

“…As a result, the safety of SS in HPSD ablation may be questionable. 33 In our study, the SS group had a statistically significant advantage in procedure time, but not in fluoroscopic or RF application times. However, considering the heterogeneity of procedure time recording and definitions across the included studies, the magnitude of such a difference (10-15 min) may lack clinical importance.…”

“…Other RF ablation techniques, such as high power and short duration (HPSD), are also available, in which a higher CF can cause steam pop. As a result, the safety of SS in HPSD ablation may be questionable 33 …”

Comparison of Effectiveness and Safety between High-Power Short-Duration Ablation and Conventional Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis

“…In the HPSD RFA group, there were 9 studies [ 16 , 17 , 23 – 25 , 27 – 29 , 32 ] where ablation was performed with a setting of 50 W, while 7 studies [ 18 , 19 , 21 , 22 , 26 , 30 , 31 ] with a power setting of 40–50 W. To reduce heterogeneity, two studies [ 20 , 32 ] exceeding the power of 50 W were excluded. Without increased complication rates, freedom from atrial arrhythmia at one year was higher in the HPSD RFA group with the power setting of 40–50 W ( P =0.03), conversely, no difference was found in this endpoint between the two groups with the power setting of 50 W ( P =0.52) (Supplementary Materials, Figure S3 ).…”

“…)e flowchart of the detailed search progress is illustrated in Figure 1. After removing the duplicated articles and browsing the abstracts, titles, or full texts, consequently, seventeen studies [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] with 4934 patients were enrolled in this meta-analysis. Among these studies, ten [16, 18-21, 23, 24, 27-29] were retrospective cohort studies and seven [17,22,25,26,[30][31][32] were prospective studies in which only one study [30] was a randomized controlled trial (RCT).…”

“…+ ATAs without * AADs Kottmaier et al + ATAs without * AADs Kumagai et al + ATAs with * + ATAs without * AADs Yavin et al [26] + ATAs without *AADsChen et al[18] …”