Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation for atrial fibrillation (AF) treatment provides effective and durable PVI associated with encouraging clinical outcome. The novel QDot ablation catheter with Qmode + ablation mode (90W/4sec, Figure 1) offers the ability to possibly improve safety and decrease ablation procedure times. Aims We aim to evaluate safety and efficacy of the very high-power short-duration (vHP-SD) temperature-controlled radiofrequency (RF) ablation Qmode + mode for pulmonary vein isolation (PVI) utilizing the novel QDot micro ablation catheter. The data was compared to conventional power-controlled ablation index (AI) guided PVI. Methods Twenty-five consecutive patients with paroxysmal or persistent AF were prospectively enrolled, underwent vHP-SD based PVI (vHP-SD group) and were compared to 25 consecutive patients treated with conventional CF-sensing catheters (control). Results All PVs were successfully isolated utilizing Qmode +. The total median RF ablation time was vHP-SD: 334 (282, 369) sec. vs control: 1567 (1250, 1756) sec. (p < 0.0001), the median procedure time was vHP-SD: 56 (48-62) vs. control: 104 (92-122) min (p < 0.0001). No differences in periprocedural complications were observed. Conclusions The novel Qmode + provides safe and effective PVI with impressive short RF time and short procedures times. Procedure time and RF time were substantial lower in the vHP-SD group. Abstract Figure 1

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Very high-power short-duration temperature-controlled ablation versus conventional ablation-index guided power-controlled ablation for pulmonary vein isolation

10.22541/au.161486257.76581818/v1 ◽

2021 ◽

Author(s):

Roland Tilz ◽

Makoto Sano ◽

Julia Vogler ◽

Thomas Fink ◽

Roza Meyer-Saraei ◽

...

Keyword(s):

Pulmonary Vein ◽

Short Duration ◽

Pulmonary Vein Isolation ◽

High Power ◽

Control Group ◽

Rf Ablation ◽

Ablation Index ◽

Procedure Duration ◽

Temperature Controlled ◽

Very High

Background: Catheter ablation for atrial fibrillation (AF) treatment provides effective and durable pulmonary vein isolation (PVI) and is associated with encouraging clinical outcome. A novel CF sensing temperature-controlled radiofrequency (RF) ablation catheter allows for very high-power short-duration (vHP-SD, 90W/4 seconds) ablation aiming a potentially safer, more effective and faster ablation. We thought to evaluate preliminary safety and efficacy of vHP-SD ablation for PVI utilizing a novel vHP-SD catheter. The data was compared to conventional power-controlled ablation index (AI) guided PVI utilizing conventional contact force (CF) sensing catheters. Methods and Results: Fifty-six patients with paroxysmal or persistent AF were prospectively enrolled in this study. Twenty-eight consecutive patients underwent vHP-SD based PVI (vHP-SD group) and were compared to 28 consecutive patients treated with conventional CF-sensing catheters utilizing the AI (control group). All PVs were successfully isolated using vHP-SD. The median RF ablation time for vHP-SD was 338 (IQR 286, 367) seconds vs control 1580 (IQR 1350, 1848) seconds (p<0.0001), the median procedure duration was vHP-SD 55 (IQR 48-60) minutes vs. control 105 (IQR 92-120) minutes (p<0.0001). No differences in periprocedural complications were observed. Conclusions: This preliminary data of the novel vHP-SD ablation mode provides safe and effective PVI. Procedure duration and RF ablation time were substantially shorter in the vHP-SD group in comparison to the control group.

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Spatial Thermodynamics of very High Power-Short Duration Catheter Ablation for Pulmonary Vein Isolation in an in-vivo model

10.22541/au.162065770.06236007/v1 ◽

2021 ◽

Author(s):

Atsushi Suzuki ◽

H. Immo Lehmann ◽

Songyun Wang ◽

Kay Parker ◽

Kristi Monahan ◽

...

Keyword(s):

Catheter Ablation ◽

Pulmonary Vein ◽

Short Duration ◽

Pulmonary Vein Isolation ◽

Contact Force ◽

High Power ◽

Tissue Temperature ◽

In Vivo Model ◽

Very High

Introduction: The spatial thermodynamics of very high power-short duration (vHPSD) radiofrequency (RF) application during pulmonary vein isolation (PVI) in in-vivo model has not been well characterized. This study was conducted to investigate the distance-temperature relationship during vHPSD-RF ablation. Methods: PVI was performed using the vHPSD catheter with the settings of 90W, RF time of 4 sec and 15mL/min irrigation in a canine model. Catheter contact force (CF) of 10-20g was defined as ‘normal’ and CF >20g as ‘firm’ CF. Tissue temperature was monitored using thermocouples implanted at the surface of the left atrial-pulmonary vein junction, left phrenic nerve, and the luminal esophagus. PVI using a standard contact-force sensing catheter (SCF) (settings of 35W, 30sec and 30mL/min irrigation) was performed for comparison. Results: A total of 334 TC profiles in 4 animals was investigated. Time to maximum tissue temperature (MTT) (6.0sec [vHPSD/normal CF] vs. 30.5 sec [SCF/normal CF], p<0.001; 8.0sec [vHPSD/firm CF] vs. 24.0sec [SCF/firm CF], p=0.022) was shorter with vHPSD than in SCF groups. MTT within 10mm from catheter-tip was lower in vHPSD ablation with normal CF than using SCF ablation (median 41.9°C [interquartile-range; 40.2-46.1] vs. 49.5°C [45.9-56.2], p=0.013). The distance margin to keep the MTT below 39ºC, 42ºC, and 50ºC were 4.9mm, 4.2mm, and 3.4mm, respectively in the vHPDS group. This margin was larger (8.0mm, 6.6mm, and 4.6mm) in the SCF group. Conclusion: Our study underscores that vHPSD creates greater resistive heating than conventional catheter ablation.

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Temperature controlled high power short duration ablation with 90 watts for 4 seconds: Outcome, safety, biophysical characteristics and cranial MRI findings in patients undergoing pulmonary vein isolation

10.22541/au.162308145.53421927/v1 ◽

2021 ◽

Author(s):

Marc Kottmaier ◽

Leonie Förschner ◽

Nada Harfoush ◽

Felix Bourier ◽

Sarah Mayr ◽

...

Keyword(s):

Pulmonary Vein ◽

Short Duration ◽

Pulmonary Vein Isolation ◽

High Power ◽

Tissue Temperature ◽

Neurological Deficits ◽

Cerebral Lesions ◽

Number Of Patients ◽

Cerebral Mri ◽

Temperature Controlled

Background High power short duration (HPSD) radiofrequency-ablation (RFA) is highly efficient and safe while reducing procedure and RF time in pulmonary vein isolation (PVI). The QDot-catheter is a novel contact-force ablation catheter that allows automated flow and power adjustments depending on the local tissue temperature to maintain a target temperature during 90watts/4seconds lesions. We analysed intraprocedural data and periprocedural safety using the QDot-catheter in patients undergoing PVI for paroxysmal atrial fibrillation (PAF). Methods We included n=48 patients undergoing PVI with the QDot-catheter with a temperature controlled HPSD ablation mode with 90watts/4seconds (TC-HPSD). If focal reconnection occurred besides repeat ablation the ablation mode was changed to 50watts/15seconds (QMode). N=23 patients underwent cerebral MRI to detect silent cerebral lesions. Results Mean RF-time was 8.1+/-2.8min, procedure-duration was 84.5+/-30min. The overall maximal measured catheter-tip temperature was 52.0°C +/- 4.6°C, mean overall applied current was 871mA +/-44mA and over all applied energy was 316J +/-47J. The mean local impedance-drop was 12.1 +/- 2.4 Ohms. During Adenosine challenge n=14 (29%) patients showed dormant conduction. A total of n=24 steam pops were detected in n=18 patients (39.1%), while no pericardial tamponade occurred. No periprocedural thromboembolic complications occurred, while n=4 patients (17.4%) showed silent cerebral lesion. Conclusion TC-HPSD ablation with 90watts/4seconds using the QDot-catheter led to a reduction of procedure and RF time, while no major complications occurred. Despite optimized temperature control and power adjustment steam pops occurred in a rather high number of patients, while none of them lead to tamponade or to clinical or neurological deficits.

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