Very high power very short duration ablation for atrial fibrillation: With great power comes great responsibility

Gupta, Dhiraj; Calvert, Peter

doi:10.1111/jce.15432

Cited by 5 publications

(9 citation statements)

References 9 publications

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“…Patient movement is more likely without GA, and loss of contact during vHPSD ablation can significantly affect the lesion delivered. For example, a 1-s loss of contact represents 5% of a 20-s sRF lesion, but 25% of a 4-s vHPSD lesion [ 23 ]. This can adversely affect acute outcomes [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Patient experience of very high power short duration radiofrequency ablation for atrial fibrillation under mild conscious sedation

Chu

Calvert

Sidhu

et al. 2022

J Interv Card Electrophysiol

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Background Very high power short duration (vHPSD) radiofrequency ablation (RFA) may reduce ablation times and improve patient tolerability, permitting pulmonary vein isolation (PVI) under mild conscious sedation (mCS) and promoting same day discharge (SDD). Methods First, a retrospective feasibility study was performed at 2 tertiary cardiac centres in the UK. Consecutive cases of first-time PVI using vHPSD ablation with 90 W lesions for up to 4 s were compared against cases performed using standard RF (sRF) and cryoballoon (Cryo) therapy. Subsequently, a prospective study of patients who had vHPSD or Cryo exclusively under mCS was undertaken. Questionnaires based on Likert and visual analogue scales (VAS) were used to measure anxiety, discomfort and pain. Results In total, 182 patients (59 vHPSD, 62 sRF and 61 Cryo) were included in the retrospective study, with 53 (90%) of vHPSD cases successfully performed under mCS. PVI ablation time in the vHPSD group (5.8 ± 1.7 min) was shorter than for sRF (16.5 ± 6.3 min, p < 0.001) and Cryo (17.5 ± 5.9 min, p < 0.001). Fifty-one vHPSD and 52 Cryo patients were included in the prospective study. PVI ablation time in the vHPSD group was shorter than for the Cryo group (6.4 ± 2.9 min vs 17.9 ± 5.7 min, p < 0.001), but overall procedure duration was longer (121 ± 39 min vs 95 ± 20 min, p < 0.001). There were no differences in the patient experience of anxiety, discomfort or pain. SDD rates were the same in both groups (61% vs 67%, p = 0.49). Conclusions vHPSD RFA for PVI can be performed under mCS to achieve SDD rates comparable to cryoablation, without compromising patient experience.

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Section: Discussionmentioning

confidence: 99%

Patient experience of very high power short duration radiofrequency ablation for atrial fibrillation under mild conscious sedation

Chu

Calvert

Sidhu

et al. 2022

J Interv Card Electrophysiol

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“…Although the rate of clinical apparent stroke and TIA is reported to be low initial cerebral magnetic resonance imaging (MRI) data after QMODE+ based PVI showed silent cerebral lesions in 6/23 (26%) patients. Since coagulation on the catheter tip was detected at the end of the procedure suggesting this observation to being related to those events 19,44 . Therefore, the RF generator software has been recently modified aiming to reduce the rate catheter tip coagulation.…”

Section: Pulmonary Vein Isolation Utilizing the Qdot Micro™ Cathetermentioning

confidence: 99%

“…Since coagulation on the catheter tip was detected at the end of the procedure suggesting this observation to being related to those events. 19,44…”

Section: Pulmonary Vein Isolation Utilizing the Qdot Micro™ Cathetermentioning

confidence: 99%

“…Recently 3D mapping and point‐by‐point based catheter ablation achieved several improvements by implementing contact force (CF), ablation index (AI), or lesion size index (LSI) guided RF ablation which have been shown to decrease procedure time, improving safety and patient outcomes 15,16 . Latest achievements are high‐power short‐duration (HP‐SD) ablation with a maximum of 50 W and very HPSD (vHPSD) ablation with maximum of 70–90 W which have been introduced to clinical practice 17–22 . In CF‐guided ablation procedures power is limited to 50 W, 23,24 while in a power‐controlled ablation mode without CF sensing catheter power is limited to 70 W 18,25 .…”

Section: Introductionmentioning

confidence: 99%

“…15,16 Latest achievements are high-power shortduration (HP-SD) ablation with a maximum of 50 W and very HPSD (vHPSD) ablation with maximum of 70-90 W which have been introduced to clinical practice. [17][18][19][20][21][22] In CF-guided ablation procedures power is limited to 50 W, 23,24 while in a power-controlled ablation mode without CF sensing catheter power is limited to 70 W. 18,25 Although these concepts seem to be safe and effective, no real-time temperature monitoring is possible because conventional catheters were utilized in those studies. 18,[23][24][25] However, it has been shown that real-time subendocardial tissue temperature monitoring during RF energy delivery is a direct indicator of lesion formation but measurements by temperature sensors embedded in the catheter tip have been shown to be not an accurate indicator of actual tissue temperature.…”

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confidence: 99%

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Very high‐power short‐duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series

Heeger,

Kuck,

Tilz

2023

Cardiovasc electrophysiol

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The QDOT MICRO™ Catheter is a novel open‐irrigated contact force‐sensing radiofrequency ablation catheter. It offers very high‐power short‐duration (vHPSD) ablation with 90 W for 4 s to improve safety and efficacy of catheter ablation procedures. Although the QDOT MICRO™ Catheter was mainly designed for pulmonary vein isolation (PVI) its versatility to treat atrial fibrillation (AF) and other types of arrhythmias was recently evaluated by the FAST and FURIOUS study series and other studies and will be presented in this article. Available study and registry data as well as case reports concerning utilization of the QDOT MICRO™ Catheter for the treatment of cardiac arrhythmias including AF, focal and macroreentry atrial tachycardia, typical atrial flutter by cavotricuspid isthmus block, premature ventricular contractions, and accessory pathways were reviewed and summarized. In summary, the QDOT MICRO™ Catheter showed safety and efficacy for PVI and is able to treat also other types of arrhythmias as is was recently evaluated by case reports and the FAST and FURIOUS studies.

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Clinical outcomes with very high power very short duration ablation for atrial fibrillation: The jury is still out

Calvert

Gupta

2022

Cardiovasc electrophysiol

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While the landscape of atrial fibrillation (AF) ablation is changing rapidly, radiofrequency (RF) remains the current gold standard. Approaches such as very high power, very short duration (vHPvSD) ablation, using 90 W 4 s lesions, attempts to improve safety outcomes by altering the lesion profile such that damage to surrounding noncardiac structures is potentially minimized. 1,2 It is reasonable to assume that ablation and procedural times are also likely to be improved. However, these benefits are likely to be more relevant if clinical outcomes with vHPvSD are at least noninferior to standard RF ablation. Is this the case?We recently reviewed data from initial vHPvSD studies showing somewhat disappointing first pass isolation (FPI) and acute reconnection rates compared with standard RF ablation (sRF). 3 It is important to note that whilst these parameters are excellent acute markers for clinical efficacy, they are not a substitute for clinical outcome data on follow up. In this edition of the Journal of Cardiovascular Electrophysiology, Mueller and colleagues present the results of a single center, retrospective, propensity matched study comparing 12-month outcomes of ablation with 90 W (vHPvSD)versus Ablation Index (AI) guided 50 W (sRF) in 84 patients. 4 They found that 90 W vHPvSD ablation was associated with shorter ablation times (10.5 vs. 17.4 min; p = .001), but with lower FPI rates (40% vs. 62%; p = .049), higher AF recurrence during the blanking period (38% vs. 12%; p = .007), and a trend towards a lower freedom from AF at 12 months (62% vs. 75%; p = .071).

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Very high power very short duration ablation for atrial fibrillation: With great power comes great responsibility

Cited by 5 publications

References 9 publications

Patient experience of very high power short duration radiofrequency ablation for atrial fibrillation under mild conscious sedation

Patient experience of very high power short duration radiofrequency ablation for atrial fibrillation under mild conscious sedation

Very high‐power short‐duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series

Clinical outcomes with very high power very short duration ablation for atrial fibrillation: The jury is still out

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