High-Power Radiofrequency Catheter Ablation of Atrial Fibrillation

Baher, Alex; Kheirkhahan, Mobin; Rechenmacher, Stephen; Marashly, Qussay; Kholmovski, Eugene; Siebermair, Johannes; Acharya, Madan; Aljuaid, Mossab; Morris, Alan; Kaur, Gagandeep; Han, Frederick T.; Wilson, Brent D.; Steinberg, Benjamin A.; Marrouche, Nassir F.; Chelu, Mihail G.

doi:10.1016/j.jacep.2018.07.017

Cited by 83 publications

(47 citation statements)

References 21 publications

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“…This was shown in a recently published multicenter study by Winkle et al where long procedure times and RF times were found despite the use of a heterogeneous HPSD strategy. Baher et al used 50 W for 5 seconds and found similar safety and efficacy with shorter procedure duration, compared with conventional PVI. Bourier et al found larger but shallower lesions with similar lesion volumes, using HPSD in an in vitro model.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter

Berte

Hilfiker

Russi

et al. 2019

Cardiovasc electrophysiol

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Introduction The CLOSE protocol combines ablation index (AI) and ≤6 mm interlesion distance using standard power settings for the treatment of atrial fibrillation (AF). The purpose was to compare the safety and efficacy of a conventional CLOSE and a higher power shorter duration (HPSD)‐CLOSE pulmonary vein isolation (PVI) strategy. Methods and Results All consecutive patients referred for PVI were included after informed consent was obtained from them. Group 1 was treated with a standard CLOSE protocol and group 2 with a HPSD‐CLOSE protocol (45 W anterior and 35 W posterior). Procedural parameters and 6‐month follow‐up were analyzed. In total, 174 patients (group 1: n = 94 [paroxysmal: n = 74]; group 2: n = 80 [paroxysmal: n = 65], similar baseline characteristics) were included. PVI was reached in all, but procedure duration (82 ± 18 minutes vs 100 ± 22 minutes; P < .0001) and radiofrequency (RF) time (23 ± 5 minutes vs 36 ± 11 minutes; P < .0001) was shorter in group 2. First pass isolation was similar in groups 2 and 1 (left veins: 94% vs 90%; P = .42 and right veins: 83% vs 84%; P = .79, respectively). Six‐month off‐ antiarrhythmic drugs freedom of AF/AT was similar in groups 2 and 1 (82% [paroxysmal: 86%] vs 83% [paroxysmal: 88%]; P = .93, respectively). Major complications were similar (group 2: 1% vs group 1: 3%; P = .39). Conclusion A higher‐power short duration approach can shorten a CLOSE procedure and reduce ablation time without having a negative impact on safety or efficiency.

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Section: Discussionmentioning

confidence: 99%

Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter

Berte

Hilfiker

Russi

et al. 2019

Cardiovasc electrophysiol

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“…15 The incidence of the esophageal thermal injury assessed by late gadolinium enhancement magnetic resonance imaging in HP short-duration RF application (50 W for 5 seconds) was reported to be similar to that in LP long-duration RF application (≤35 W for 10 to 30 seconds). 12 The incidence of endoscopically detected esophageal lesion after AI-guided PV isolation with relatively HP RF application on the esophagus (35 W, target AI > 300) was reported to be low (erythema/erosion was 1.2% and no ulceration). 16 These results suggested that the relatively HP short-duration RF application could complete CPVI safely.…”

Section: Complicationsmentioning

confidence: 98%

“…[6][7][8] However, these studies did not evaluate the impact of RF application power on AI-guided CPVI. Several previous studies reported that HP RF application could reduce procedure time [9][10][11][12] but might increase complications related to RF application (steam pops, pericardial effusion and gastrointestinal complaints). 10 Theoretically, AI-guided HP RF application can create similar RF lesions for a short duration without excessive RF application.…”

mentioning

confidence: 99%

High‐power application is associated with shorter procedure time and higher rate of first‐pass pulmonary vein isolation in ablation index‐guided atrial fibrillation ablation

Okamatsu

Koyama

Sakai

et al. 2019

Cardiovasc electrophysiol

107

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Backgrounds Ablation index (AI) is useful to complete circumferential pulmonary vein isolation (CPVI) for atrial fibrillation (AF), but the role of radiofrequency power in AI‐guided CPVI remains to be elucidated. Methods We investigated 60 patients with AF undergoing AI‐guided CPVI (mean age, 66 ± 9 years; nonparoxysmal AF in 16). The first 40 patients were randomly assigned to low‐power (LP; n = 20) and medium‐power (MP; n = 20) groups and the following 20 patients to high‐power (HP). In LP, radiofrequency (RF) application was done at 30 W at the anterior and 20 W at the posterior left atrial (LA) wall, while in MP, it was at 40 W at the anterior and 30 W at the posterior LA wall. In HP, 50 W was applied at the anterior, 40 W at posterior LA wall and 30 W on the esophagus. At each ablation point, target AI was 400 at the anterior, 360 at the posterior LA wall, and 260 on the esophagus. Results The time to complete both‐side CPVI was shortest in HP (median, 40 minutes, interquartile range [IQR], 28‐63) followed by MP (58 [49‐83] minutes, P = .008 vs HP) and LP (84 [72‐93] minutes, P = .002 vs MP). Higher RF power application significantly increased first‐pass isolation rate (55% in LP, 80% in MP and 85% in HP, P = .002) and decreased LA‐PV reconnection rate (10% in LP, 8% in MP, and 0% in HP, P = .03). Conclusion In AI‐guided PVI, the HP RF application can shorten the time to complete PVI with a high rate of first‐pass isolation and a low rate of LA‐PV reconnection.

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“…The complications rate was remarkably low, and this has encouraged many to start utilizing HPSD. Baher et al used gadolinium‐enhanced magnetic resonance imagings and endoscopy to evaluate 574 patients undergoing ablation at 50 W for 5 seconds and compared them with 113 patients undergoing ablation at less than 35 W for 10 to 30 seconds. Like the earlier studies, with HPSD they found a marked reduction in procedure time from 251 ± 101 to 149 ± 65 ( P < .001) and RF ablation time from 55.0 ± 19.2 to 37.9 ± 13.9 ( P < .001).…”

mentioning

confidence: 99%

High‐power short‐duration ablation: Turn up the heat to cool down the esophagus

Winkle

2019

Cardiovasc electrophysiol

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High-Power Radiofrequency Catheter Ablation of Atrial Fibrillation

Cited by 83 publications

References 21 publications

Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter

Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter

High‐power application is associated with shorter procedure time and higher rate of first‐pass pulmonary vein isolation in ablation index‐guided atrial fibrillation ablation

High‐power short‐duration ablation: Turn up the heat to cool down the esophagus

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