High‐power short‐duration versus standard radiofrequency ablation: Insights on lesion metrics

Abstract Background: High power-short duration ablation is an emerging conception for cardiac RF treatment. But the biophysical ablation properties of this technique have not been fully explored. This study compared the electric field characteristics and thermal lesion dimension in High power-short duration (HP-SD) radio frequency (RF) ablation and standard RF ablation by using the finite element method. Results: The results demonstrated that the lesion size and temperature in HP–SD RF ablation increased faster than standard RF ablation. The thermal lesion volume in both ablation modes demonstrated a linear increase and the rate of increase of HP–SD RF ablation grew faster than that of standard RF ablation. For HP–SD application at 50 W for 5 s, the lesion depth was shallower (1.74 to 2.1 mm vs 2.40 to 3.15 mm) and the surface lesion diameter was broader (2.76 to 3.32 mm vs 2.42 to 2.66 mm) than that for standard RF ablation at 25 W for 30 s. Conclusion: Compared with standard RF ablation, HP–SD RF ablation creates a broader lesion width and surface lesion diameter but shallower lesion depth, with a faster increase in temperature. HP–SD ablation is more able to achieve uniform and contiguous lesion shape, which is a suitable for point-to-point RF ablation procedures.Higher temperature was formed in deeper space of cardiac tissue in HP–SD ablation. The duration of HP–SD ablation should be strictly controlled for preventing the steam occur in tissue.

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High-power, Short-duration Radiofrequency Ablation for the Treatment of AF

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2019.09 ◽

2020 ◽

Vol 8 (4) ◽

pp. 265-272 ◽

Cited By ~ 1

Author(s):

Irum D Kotadia ◽

Steven E Williams ◽

Mark O’Neill

Keyword(s):

Radiofrequency Ablation ◽

Short Duration ◽

High Power ◽

Clinical Studies ◽

Ablation Lesion ◽

Lesion Formation ◽

Clinical Value ◽

Temperature Recording ◽

Procedural Time ◽

Tissue Oedema

High-power, short-duration (HPSD) ablation for the treatment of AF is emerging as an alternative to ablation using conventional ablation generator settings characterised by lower power and longer duration. Although the reported potential advantages of HPSD ablation include less tissue oedema and collateral tissue damage, a reduction in procedural time and superior ablation lesion formation, clinical studies of HPSD ablation validating these observations are limited. One of the main challenges for HPSD ablation has been the inability to adequately assess temperature and lesion formation in real time. Novel catheter designs may improve the accuracy of intra-ablation temperature recording and correspondingly may improve the safety profile of HPSD ablation. Clinical studies of HPSD ablation are on-going and interpretation of the data from these and other studies will be required to ascertain the clinical value of HPSD ablation.

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Impact of High-Power Short-Duration Radiofrequency Ablation on Esophageal Temperature Dynamic

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.121.010205 ◽

2021 ◽

Author(s):

Hagai D. Yavin ◽

Zachary P. Bubar ◽

Koji Higuchi ◽

Jakub Sroubek ◽

Mohamed Kanj ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Pulmonary Vein ◽

Short Duration ◽

Pulmonary Vein Isolation ◽

High Power ◽

Temperature Rise ◽

Esophageal Injury ◽

Esophageal Temperature ◽

Dynamic Profile ◽

Temperature Dynamic

Background: High-power short-duration (HP-SD) radiofrequency ablation (RFA) has been proposed as a method for producing rapid and effective lesions for pulmonary vein isolation. The underlying hypothesis assumes an increased resistive heating phase and decreased conductive heating phase, potentially reducing the risk for esophageal thermal injury. The objective of this study was to compare the esophageal temperature dynamic profile between HP-SD and moderate-power moderate-duration (MP-MD) RFA ablation strategies. Methods: In patients undergoing pulmonary vein isolation, RFA juxtaposed to the esophagus was delivered in an alternate sequence of HP-SD (50 W, 8–10 s) and MP-MD (25 W, 15–20 s) between adjacent applications (distance, ≤4 mm). Esophageal temperature was recorded using a multisensor probe (CIRCA S-CATH). Temperature data included magnitude of temperature rise, maximal temperature, time to maximal temperature, and time return to baseline. In swine, a similar experimental design compared the effect of HP-SD and MP-MD on patterns of esophageal injury. Results: In 20 patients (68.9±5.8 years old; 60% persistent atrial fibrillation), 55 paired HP-SD and MP-MD applications were analyzed. The esophageal temperature dynamic profile was similar between HP-SD and MP-MD ablation strategies. Specifically, the magnitude of temperature rise (2.1 °C [1.4–3] versus 2.0 °C [1.5–3]; P =0.22), maximal temperature (38.4 °C [37.8–39.3] versus 38.5 °C [37.9–39.4]; P =0.17), time to maximal temperature (24.9±7.5 versus 26.3±6.8 s; P =0.1), and time of temperature to return to baseline (110±23.2 versus 111±25.1 s; P =0.86) were similar between HP-SD and MP-MD ablation strategies. In 6 swine, esophageal injury was qualitatively similar between HP-SD and MP-MD strategies. Conclusions: Esophageal temperature dynamics are similar between HP-SD and MP-MD RFA strategies and result in comparable esophageal tissue injury. Therefore, when using a HP-SD RFA strategy, the shorter application duration should not prompt shorter intervals between applications.

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Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation

10.5152/anatoljcardiol.2021.243 ◽

2021 ◽

Author(s):

Dibbendhu Khanra ◽

◽

Abdul Hamid ◽

Saurabh Deshpande ◽

Anindya Mukherjee ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Low Power ◽

Short Duration ◽

High Power ◽

Meta Analysis ◽

Long Duration

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High-power short-duration radiofrequency ablation for atrial fibrillation

EP Europace ◽

10.1093/europace/euab116.257 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

K Kassa ◽

Z Nagy ◽

B Kesoi ◽

Z Som ◽

C Foldesi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Short Duration ◽

Contact Force ◽

High Power ◽

Posterior Wall ◽

Pericardial Tamponade ◽

Fluoroscopy Time ◽

Control Group

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In recent times, high-power short-duration (HPSD) radiofrequency ablation (RFA) has emerged as an alternative strategy for pulmonary vein isolation (PVI) in atrial fibrillation (AF). Purpose We aimed to compare HPSD approach and conventional, ablation-index (AI) guided PVI using contact force sensing ablation catheters in respect of efficacy, safety, procedural characteristics, and outcome. Methods A total of 184 consecutive AF patients with first PVI were enrolled (age: 60 ± 11 years, paroxysmal: 56.5%, persistent: 43.5%) between November 2016 and December 2019. An ablation protocol of 50W energy with 15-20 g contact force was used for a duration of 8-12 sec based on the loss of capture concept in the HPSD group (n = 91) meanwhile, PVI was achieved according to the conventional power settings (posterior wall 25W, AI: 400, anterior wall 35W, AI: 550 ) in the control group (n = 93). During 1-year follow-up, documented AF for more than 30 seconds was considered as recurrence. Results Radiofrequency time and procedural time were significantly shorter using HPSD ablation (26.0 ± 12.7 min vs. 42.9 ± 12.6 min, p < 0.001, and 91 ± 30.1 min vs. 105.3 ± 28 min, p < 0.001). The HPSD strategy significantly lowered fluoroscopy time and radiation dose (5.47 ± 4.07 min vs. 8.15 ± 10.04 min, p = 0.019, and 430.2 ± 534.06 cGycm2 vs. 604.2 ± 633.9 cGycm2, p = 0.046). The HPSD group showed significantly less arrhythmia recurrence during 1-year follow-up with 76.9% of patients free from AF compared to 66.7% in the control group (p = 0.037). No pericardial tamponade, periprocedural thromboembolic complication, or atrio-oesophageal fistula occurred in the HPSD group. We observed 2 pericardial tamponade and 1 periprocedural stroke in the control group. Conclusions HPSD RFA for AF was demonstrated to be safe, and lead to significantly improved 1-year outcome in our mixed patient population. HPSD protocol significantly shortened procedural and radiofrequency time with decreased fluoroscopy time and radiation exposure.

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