Recipe for Ablation Success: Don't Cook the Goose

Frankel, David S.

doi:10.1111/jce.13036

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…In current practice, power and duration are often selected for modification between two broad ablation strategies, high power, shorter duration (HPSD) and lower power, longer duration (LPLD). The conventional LPLD of 10 to 35 W (most commonly 25-35 W) for a duration of 10 to 30 s, is the more commonly used strategy [11,12]. Recently, it has been suggested that another approach of HPSD ([?…”

Section: Introductionmentioning

confidence: 99%

High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Meta-Analysis

Kewcharoen

Techorueangwiwat

Kanitsoraphan

et al. 2020

Preprint

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Background: Multiple strategies have advocation for power titration and catheter movement during atrial fibrillation (AF) ablation. Comparative favoring evidence regarding the efficacy, logistics, and safety of a higher power, shorter duration (HPSD) ablation strategy compared to a lower power, longer duration (LPLD) ablation strategy is insubstantial. We performed a metaanalysis to compare arrhythmia-free survival, procedure times, and complication rates between the two strategies. Methods: We searched MEDLINE, EMBASE and Cochrane Library from inception to April 2020. We included studies comparing patients underwent HPSD and LPLD strategies for AF ablation and reporting either of the following outcomes: freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. We combined data using the random-effects model to calculate odds ratio (OR) and weight mean difference (WMD) with 95% confidence interval (CI). Results: Nine studies from 2006-2020 involving 2,282 patients were included (1,369 patients underwent HPSD strategy and 853 patients underwent LPLD strategy). HPSD strategy was not associated with an increased freedom from AT at 12-month follow-up (OR= 1.41, 95%CI:0.90-2.21). There was a significant reduction in the HPSD group for total procedure (WMD=49.60, 95%CI:29.76-69.44) and ablation (WMD=17.92, 95%CI:13.63-22.22) times, but not for fluoroscopy time (WMD=1.15, 95%CI:-0.67-2.97). HPSD was not associated with a reduction in esophageal ulcer/atrioesophageal fistula (OR=0.35, 95%CI:0.12-1.06) or pericardial effusion/cardiac tamponade rates (OR=0.96, 95%CI:0.24-3.79). Conclusions: When compared to a LPLD strategy, HPSD strategy does not improve recurrent AT nor reduce periprocedural complication risks.However, a HPSD strategy can significantly reduce total procedure and ablation times.

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Section: Introductionmentioning

confidence: 99%

High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Meta-Analysis

Kewcharoen

Techorueangwiwat

Kanitsoraphan

et al. 2020

Preprint

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“…In current practice, power and duration are often selected for modification between two broad ablation strategies, high‐power, shorter duration (HPSD) and lower‐power, longer duration (LPLD). The conventional LPLD of 10 to 35 W (most commonly 25–35 W) for a duration of 10–30 s, is the more commonly used strategy 11,12 . Recently, it has been suggested that another approach of HPSD (≥40 W, duration of <10 s) can be used to lower the time spent per lesion, and since heat transfer in tissues is time‐dependent, reduces deep tissue heating and collateral injury 9,13 .…”

Section: Introductionmentioning

confidence: 99%

“…The conventional LPLD of 10 to 35 W (most commonly 25-35 W) for a duration of 10-30 s, is the more commonly used strategy. 11,12 Recently, it has been suggested that another approach of HPSD (≥40 W, duration of <10 s) can be used to lower the time spent per lesion, and since heat transfer in tissues is time-dependent, reduces deep tissue heating and collateral injury. 9,13 Results from experimental studies have reported that HPSD ablation approaches produce larger lesion diameters compared to LPLD that may augment lesion contiguity while still resulting in a sufficient lesion depth to ensure transmurality.…”

Section: Introductionmentioning

confidence: 99%

High‐power short duration and low‐power long duration in atrial fibrillation ablation: A meta‐analysis

Kewcharoen

Techorueangwiwat

Kanitsoraphan

et al. 2020

Cardiovasc electrophysiol

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Background: Multiple strategies have advocation for power titration and catheter movement during atrial fibrillation (AF) ablation. Comparative favoring evidence regarding the efficacy, logistics, and safety of a higher-power, shorter duration (HPSD) ablation strategy compared to a lower-power, longer duration (LPLD) ablation strategy is insubstantial. We performed a meta-analysis to compare arrhythmia-free survival, procedure times, and complication rates between the two strategies.Methods: We searched MEDLINE, EMBASE, and Cochrane Library from inception to September 2020. We included studies comparing patients who underwent HPSD and LPLD strategies for AF ablation and reporting either of the following outcomes:Freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. We combined data using the random-effects model to calculate the odds ratio (OR) and weight mean difference (WMD) with a 95% confidence interval (CI).Results: Ten studies from 2006 to 2020 involving 2274 patients were included (1393 patients underwent HPSD strategy and 881 patients underwent LPLD strategy). HPSD strategy was not associated with increased freedom from AT at 12-month follow-up (OR = 1.54, 95% CI: 0.99 to 2.40, p = .054). In the subgroup analysis of the randomized controlled trial, the HPSD strategy was associated with

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“…A lower-power, long-duration (LPLD) ablation (10-35 W for 10-30 seconds) is commonly used on the posterior wall. [13][14] In contrast, a high-power, short-duration (HPSD) ablation (50 W for 2-15 seconds) during the PVI has been advocated to decrease the procedure time without an increase in complications. [15][16][17][18][19] However, the optimal RF power and duration settings on the posterior wall near the esophagus are not fully elucidated and studies about HPSD ablation during BOXI are limited.…”

Section: Introductionmentioning

confidence: 99%

“…Although a durable lesion formation of the PVI or BOXI is essential for successful outcomes, ablation on the posterior wall has a risk of esophageal injury. A lower‐power, long‐duration (LPLD) ablation (10‐35 W for 10‐30 seconds) is commonly used on the posterior wall 13‐14 . In contrast, a high‐power, short‐duration (HPSD) ablation (50 W for 2‐15 seconds) during the PVI has been advocated to decrease the procedure time without an increase in complications 15‐19 .…”

Section: Introductionmentioning

confidence: 99%

High‐power, short‐duration ablation during Box isolation for atrial fibrillation

Kumagai

Toyama

2020

Journal of Arrhythmia

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Recipe for Ablation Success: Don't Cook the Goose

Cited by 4 publications

References 5 publications

High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Meta-Analysis

High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Meta-Analysis

High‐power short duration and low‐power long duration in atrial fibrillation ablation: A meta‐analysis

High‐power, short‐duration ablation during Box isolation for atrial fibrillation

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