Safe and effective delivery of high-power, short-duration radiofrequency ablation lesions with a flexible-tip ablation catheter

Ptaszek, Leon M.; Koruth, Jacob S.; Piccini, Jonathan P.; Ranjan, Ravi; Mahapatra, Srijoy; Pipenhagen, Catherine; Fish, Jessica; Moon, L. Boyce; Ambrosius, Nicholas M.; Boudlali, Hana; Jensen, Jakob D.

doi:10.1016/j.hroo.2022.10.009

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…The latter was detected in a redo-procedure and confirmed in CT-scan. A trial by Ptaszek et al 8 comparing LPLD to VHPSD (70 W/7 s) did not show significant differences in the occurrence of PV-stenosis using both technologies. 8 PV stenosis remains a rare complication of singletip RF ablation but is rather associated with a distal isolation of PV then the power setting used in our trial.…”

Section: Main Findingsmentioning

confidence: 89%

“…Therefore, the power setting of VHPSD potentially spares adjacent tissues (e.g., esophagus and phrenic nerve). 7,8 Previous studies have proven VHPSD to be safe and equally effective to LPLD with significantly shorter procedure time and superior long-term outcome. [9][10][11] As a new "single shot" device the new nonthermal pulsed field ablation (PFA) modality has been implemented into clinical routine.…”

Section: Introductionmentioning

confidence: 99%

“…An in vitro animal model from Bourier et al showed that lesions set with LPLD (30 W, 30 s) had a mean width of 7.5 mm with a depth of 5.7 mm, while VHPSD lesions had a mean width of 10.3 mm with a depth of 3.9 mm. Therefore, the power setting of VHPSD potentially spares adjacent tissues (e.g., esophagus and phrenic nerve) 7,8 …”

Section: Introductionmentioning

confidence: 99%

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Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Wörmann,

Schipper,

Lüker

et al. 2023

Cardiovasc electrophysiol

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BackgroundThe newly introduced nonthermal pulsed field ablation (PFA) is a promising technology to achieve fast pulmonary vein isolation (PVI) with high acute success rates and good safety features. However, previous studies have shown that very high power short duration ablation (VHPSD) is also highly effective and fast to achieve PVI with potentially less arrhythmia recurrence compared to conventional radiofrequency ablation. Data comparing PFA to VHPSD‐PVI is lacking.ObjectiveThis study compared procedural and outcome data for PFA‐PVI to VHPSD‐PVI in patients with paroxysmal or persistent atrial fibrillation (PAF/persAF).MethodsConsecutive patients undergoing de novo PVI (PFA or VHPSD) were included in this analysis. For PFA‐PVI a pentaspline 20 electrode catheter was used. For VHPSD‐PVI an enhanced irrigated catheter with a power setting of 70 W/7 s (70 W/5 s at posterior wall) was employed in conjunction with electro‐anatomical mapping. All procedures were performed in deep analgo‐sedation.ResultsA total of n = 114 patients (n = 57[50%] PFA, n = 17[30%] PAF; n = 40[70%] persAF) were included in this analysis. PVI was successful in all patients. The PFA group revealed a significantly shorter procedure duration (65 ± 17 min vs. 95 ± 23 min, p < 0.01) but longer fluoroscopy time (PFA 15 ± 5 min and VHPSD 12 ± 3 min; p < 0.001). At follow‐up after median 125 days (interquartile range: 109–162) n = 46 PFA (80.7%) and n = 44 VHPSD pts (77.2%) were free from atrial arrhythmia after a single procedure (p = 0.819).Two tamponades occurred in the PFA while in VHPSD two pts suffered groin bleedings. One clinically nonsignificant PV stenosis occurred in the VHPSD group.ConclusionPulsed‐field ablation and VHPSD‐PVI seem to be highly effective and safe to achieve PVI in the setting of PAF and persAF with comparable arrhythmia‐free survival. However, procedure duration for PFA PVI is significantly shorter and therefore may be of potential benefit. Compared to PFA VHPSD‐PVI might ensure information on left atrial substrate allowing to target concomitant secondary tachycardias.

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Section: Main Findingsmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Wörmann,

Schipper,

Lüker

et al. 2023

Cardiovasc electrophysiol

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“…Although radiofrequency applications are reported to be more safely achieved using a catheter featuring an innovative irrigation manner with a surface thermocouple, 18 , 19 the optimized strategy to increase lesion size without raising the risk of steam pops to eliminate arrhythmogenic regions deep within the myocardium has still posed a significant challenge. 2 , 3 While longer RF applications were traditionally thought to enlarge lesion size, existing evidence primarily relied on power‐controled modes with standard irrigation catheters, often capping application duration at 60 s. 8 , 9 , 10 , 20 , 21 Systematic experiments addressing whether very‐long RF applications can significantly increase lesion size without elevating the risk of steam pops have been lacking.…”

Section: Discussionmentioning

confidence: 99%

An optimized approach for increasing lesion size in temperature‐controled setting using a catheter with a surface thermocouple and efficient irrigation

Takigawa,

Yamaguchi,

Goya

et al. 2024

Journal of Arrhythmia

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BackgroundWe explore an optimized approach for increasing lesion size using a novel ablation catheter with a surface thermocouple and efficient irrigation in a temperature‐control setting.MethodsWe conducted radiofrequency applications at various power levels (35 W, 40 W, and 45 W), contact forces (CFs, 10 g/20 g), and durations (60 s/120 s/180 s) in perpendicular/parallel catheter orientations, with normal saline irrigation (NS‐irrigation) and Half NS‐irrigation (HNS‐irrigation) in an ex‐vivo model (Step 1). In addition, we performed applications (35 W/40 W/45 W for 60 s/120 s/180 s in NS‐irrigation and 35 W/40 W for 60 s/120 s/180 s in HNS‐irrigation) in four swine (Step 2), evaluating lesion characteristics and the occurrence of steam pops.ResultsIn Step 1, out of 288 lesions, we observed 47 (16.3%) steam pops, with 13 in NS‐irrigation and 34 in HNS‐irrigation (p = .001). Although steam pops were mostly observed with the most aggressive setting (45 W/180 s, 54%) with NS‐irrigation, they happened in less aggressive settings with HNS irrigation. Lesion size significantly increased with longer‐duration ablation but not with HNS‐irrigation. The optimal %impedance‐drop cutoff to predict steam pops was 20% with a negative‐predictive‐value (NPV) = 95.1% including NS‐ and HNS‐irrigation groups, and 22% with an NPV = 96.1% in NS‐irrigation group. In Step 2, similar to the ex‐vivo model, lesion size significantly increased with longer‐duration ablation but not with HNS‐irrigation. Steam pops were absent with NS‐irrigation (0/35) even with the largest %impedance‐drop reaching 31% at 45 W/180 s. All steam pops were observed with HNS‐irrigation (6/21, 29%). The optimal %impedance‐drop cutoff predicting steam pops was 24% with an NPV = 96.3% including both NS‐ and HNS‐irrigation groups.ConclusionsRather than using HNS‐irrigation, very long‐duration of radiofrequency applications up to 45 W/180 s may be recommended to safely and effectively increase lesion dimensions using this catheter with NS‐irrigation.

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“…In this context, irrigated catheters were equipped with tip thermocouples in order to get tissue/tip temperature feedback and thus achieve a real “temperature-controlled” RF delivery (Qdot Micro, Biosense Webster, and DiamondTemp, Medtronic). Finally, the point-by-point RF delivery evolved increasingly moving towards greater speeding up of the procedure: protocols based on the delivery of high-power/short-duration and very high-power/very short-duration are included in this context [ 48 , 49 , 50 , 51 ].…”

Section: Energy Sources For Af Ablationmentioning

confidence: 99%

Ablation of Paroxysmal Atrial Fibrillation: between Present and Future

Robles,

Palamà,

Scarà

et al. 2024

Rev. Cardiovasc. Med.

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Pulmonary vein isolation (PVI) is the established cornerstone for atrial fibrillation (AF) ablation, indeed current guidelines recognize PVI as the gold standard for first-time AF ablation, regardless of if it is paroxysmal or persistent. Since 1998 when Haïssaguerre pioneered AF ablation demonstrating a burden reduction after segmental pulmonary vein (PV) ablation, our approach to PVI was superior in terms of methodology and technology. This review aims to describe how paroxysmal atrial fibrillation ablation has evolved over the last twenty years. We will focus on available techniques, a mechanistic understanding of paroxysmal AF genesis and the possibility of a tailored approach for the treatment of AF, before concluding with a future perspective.

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Safe and effective delivery of high-power, short-duration radiofrequency ablation lesions with a flexible-tip ablation catheter

Cited by 7 publications

References 36 publications

Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

An optimized approach for increasing lesion size in temperature‐controled setting using a catheter with a surface thermocouple and efficient irrigation

Ablation of Paroxysmal Atrial Fibrillation: between Present and Future

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