Relationship between luminal esophageal temperature and volume of esophageal injury during RF ablation: In silico study comparing low power‐moderate duration vs. high power‐short duration

Abstract Introduction Recent clinical data show that high-power, short-duration (HPSD) radiofrequency (RF) ablation can result in a similar esophageal injury rate as traditional low-power, long-duration (LPLD) ablation. Existing methods to prevent esophageal injury have yielded mixed results and can result in prolonged procedure time, potentially increasing the incidence of post-operative cognitive dysfunction. A new esophageal cooling device currently available for whole-body temperature modulation is being studied for the prevention of esophageal injury during LPLD RF ablation and cryoablation. We sought to develop a mathematical model of HPSD ablation in order to quantify the capability of this new esophageal cooling device to protect from esophageal injury under high-power conditions. Methods Using a model we developed of HPSD RF ablation in the left atrium, we measured the change in esophageal lesion formation and the depth of lesions (measured as percent transmurality) with the esophageal cooling device in place and operating at a temperature from 5°C to 37°C. Tissue parameters, including thermal conductivity, were set to average values obtained from existing literature, and energy settings were evaluated at 50W for between 5 and 10 seconds, and at 90W for a duration of 4 seconds. Results Esophageal injury as measured by percent transmurality was considerably higher at 50W and 10s duration than at 90W of power with 4s duration, although both settings showed potential for esophageal injury. The protective effect of the esophageal cooling device was evident for both cases, with a greater effect when using 50W for 10s (Figure 1). At the coldest device settings, using a 5 min pre-cooling period also reduced the transmurality of the intended atrial lesions. Esophageal protection in HPSD ablation Conclusions Esophageal cooling with a new patient temperature management device shows protective effects against thermal injury during RF ablation across a range of tissue thermal conductivity, using a variety of high-power settings, including 90W applied for 4 seconds. Adjusting the cooling power by adjusting the circulating water temperature in the device allows for a tailoring of the protective effects to operating conditions. Acknowledgement/Funding Attune Medical

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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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In silico analysis of the relation between conventional and high‐power short‐duration RF ablation settings and resulting lesion metrics

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.14495 ◽

2020 ◽

Vol 31 (6) ◽

pp. 1332-1339 ◽

Cited By ~ 1

Author(s):

Felix Bourier ◽

Konstantinos Vlachos ◽

Antonio Frontera ◽

Claire A. Martin ◽

Anna Lam ◽

...

Keyword(s):

Short Duration ◽

High Power ◽

In Silico ◽

In Silico Analysis ◽

Rf Ablation ◽

Silico Analysis

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Abstract 12970: High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.12970 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jakrin Kewcharoen ◽

Chol Techorueangwiwat ◽

Chanavuth Kanitsoraphan ◽

Thiratest Leesutipornchai ◽

Wasawat Vutthikraivit ◽

...

Keyword(s):

Atrial Fibrillation ◽

Low Power ◽

High Power ◽

Injury Risk ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Esophageal Injury ◽

Procedure Time ◽

Case Control Studies ◽

Large Populations

Background: Although high power, shorter duration (HPSD) ablation and low power, longer duration (LPLD) ablation strategies for atrial fibrillation (AF) are frequently advocated to enhance safety and efficacy, there exists a need for comparative data from large populations. We performed a meta-analysis to compare arrhythmia-free survival, procedure time and complications rates between the two strategies. Methods: We searched the databases of MEDLINE and EMBASE from inception to April 2020. Included studies were case-control studies, cohort studies, or randomized controlled trials that compared patients undergoing HPSD and LPLD strategies for AF ablation and reported either of the following outcomes: freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. Data from each study were combined using the random-effects model to calculate odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI). Results: Ten studies from 2006 to 2020 involving 2,189 patients were included (1,350 patients underwent HPSD strategy and 839 patients underwent LPLD strategy). Both HPSD and LPLD strategies resulted in a similar freedom from AT at 12-month follow-up (OR=1.36, 95% CI:0.91-2.04, p=0.13, Figure 1A). HPSD strategy did result in a significant reduction in total procedure time (WMD=47.34, 95% CI:29.47-65.21, p<0.001, Figure 1B) compared to LPSD. HPSD wasn’t associated with reduction in esophageal ulcer/arterioesophageal fistula (OR=0.35, 95%CI=0.12-1.06, p=0.06) or pericardial effusion/cardiac tamponade (OR=0.96, 95%CI: 0.24-3.79, p=0.95) Conclusions: In this large meta-analysis both LPLD and HPSD are equally effective and safe. Although HPSD is often advocated to reduce esophageal injury, risk was similar between approaches. However, HPSD strategy significantly lowers procedure times.

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Histopathological Changes by Low-Power-Long-Duration and High-Power-Short-Duration Subthreshold Laser Treatment in the Rabbit Retina

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2009.50.3.440 ◽

2009 ◽

Vol 50 (3) ◽

pp. 440

Author(s):

Joo Eun Lee ◽

Kyeong Hwan Kim ◽

Seung Youn Jea ◽

Ji Eun Lee ◽

Jong Soo Lee ◽

...

Keyword(s):

Low Power ◽

Laser Treatment ◽

Short Duration ◽

High Power ◽

Rabbit Retina ◽

Histopathological Changes ◽

Long Duration ◽

Subthreshold Laser

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Thermal and electric Characteristics of High-power Short-duration Radiofrequency Ablation and Standard Radiofrequency Ablation: A Computer Simulation Study

10.21203/rs.3.rs-580584/v1 ◽

2021 ◽

Author(s):

Kaihao Gu ◽

Shengjie Yan ◽

Xiaomei Wu

Keyword(s):

Radiofrequency Ablation ◽

Short Duration ◽

High Power ◽

Lesion Size ◽

Lesion Volume ◽

Rf Ablation ◽

Thermal Lesion ◽

Lesion Depth ◽

Lesion Diameter ◽

Rate Of Increase

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

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.14806 ◽

2020 ◽

Author(s):

Jakrin Kewcharoen ◽

Chol Techorueangwiwat ◽

Chanavuth Kanitsoraphan ◽

Thiratest Leesutipornchai ◽

Nazem Akoum ◽

...

Keyword(s):

Atrial Fibrillation ◽

Low Power ◽

Short Duration ◽

High Power ◽

Meta Analysis ◽

Atrial Fibrillation Ablation ◽

Long Duration

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High-Power Short-Duration Atrial Fibrillation Ablation: Strategy to Reduce Luminal Esophageal Temperature With Contact Force Catheters

SSRN Electronic Journal ◽

10.2139/ssrn.3818015 ◽

2021 ◽

Author(s):

Fabricio Sarmento Vassallo ◽

Lucas Luis Meigre ◽

Eduardo Giestas Serpa ◽

Christiano Lemos da Cunha ◽

Aloyr Gonçalves Simões Jr. ◽

...

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

Contact Force ◽

High Power ◽

Atrial Fibrillation Ablation ◽

Esophageal Temperature

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P4763High power radiofrequency ablation with fixed short duration is rapid, efficient and safe for circumferential pulmonary vein isolation

European Heart Journal ◽

10.1093/eurheartj/ehz745.1139 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Schreieck ◽

M Duckheim ◽

U Yurtbil ◽

J Flassak ◽

C Scheckenbach ◽

...

Keyword(s):

Left Atrium ◽

Short Duration ◽

Temperature Rise ◽

Posterior Wall ◽

Rf Ablation ◽

Esophageal Temperature ◽

Single Spot ◽

Rf Applications ◽

Circumferential Pulmonary Vein Isolation

Abstract Background Short duration 50 Watt radiofrequency (RF) ablation has been shown to be feasible for atrial fibrillation (AF) ablation with short procedure times. Purpose We evaluated 50 Watt RF power with a different fixed short application duration at the anterior and posterior left atrial wall using contact force (CF) sensing catheters for circumferential pulmonary vein isolation (PVI). Methods Consecutive patients (pts) with indication for de novo AF ablation (n=40, age 64±12 years) with paroxysmal (n=23) or persistent (n=17) AF underwent high density 3D mapping of the left atrium. Low voltage areas of more than 5% of the left atrium were only found in 20% of pts. Thereafter, circumferential PVI using CF sensing catheters was performed. For each RF application (50 Watt, RF duration 11–13s at the anterior wall, 9–11s at the posterior wall) a stable catheter tip position with minimal mean CF of 3g was required and application was stopped in case of CF more than 30g. Esophageal temperature measurement was performed with temperature cut off 39.0°C. In case of temperature rise, ablation protocol was switched to conventional 20 Watt RF applications for ablation adjacent to the esophagus. Results Complete PVI was achieved in all pts with 81±29 short RF applications resulting in cumulative RF applications duration of 13.1±4.2min and an ablation duration of 59±17min for complete PVI. Even RF application with low CF (3–5g) were effective. Due to esophageal temperature rise, switch to conventional RF application with 20 Watt was performed in 43% of pts at least at one posterior PV entrance. After a waiting period of 20 min only in 33% of pts any PV conduction recurs, in 28% of pts only at a single spot and reconnected fibers were not associated with low CF application at that spot, but clearly associated with low energy application at the posterior wall. All PV were successfully re-isolated in most of pts with a single spot high energy RF application. No serious complications occurred in association with PVI. Follow up will be available at presentation time. Conclusion RF ablation with 50 Watt fixed short duration is efficient and safe for circumferential PVI. Ablation procedure durations are shorter and early recurrence rates are lower compared to reported conventional ablation procedures. The importance of CF titration seems to be diminished by 50 Watt RF applications in the left atrium. Further follow up have to be waited.

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