scholarly journals High- power radiofrequency ablation guided by ablation index for pulmonary vein isolation

2020 ◽  
Author(s):  
Xuefeng Zhu ◽  
Chunxiao Wang ◽  
Jianping Li ◽  
Wenjing Li ◽  
Hongxia Chu ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Anterior Wall ◽  
Maximum Diameter ◽  
Ablation Index ◽  
Adenosine Administration ◽  
Rf Applications ◽  
Posterior Anterior ◽  
Pulmonary Vein Reconnection

Abstract Background Proposed to facilitate pulmonary vein isolation (PVI), high-power ablation may cause extracardiac damage. This study evaluated the safety and efficacy of ablation index (AI) guided high-power ablation first in an animal model and subsequently in a clinical study. Methods Outcomes of radiofrequency (RF) applications were compared in a swine ventricular endocardial model (n = 10 each for 50W, 40W and 30W; AI = 500), and in 100 consecutive patients with paroxysmal atrial fibrillation undergoing PVI (40W [last n = 50] vs. 30 W [first n = 50]; target AI = 400/500 on posterior/anterior wall, respectively). Acute PV reconnection was assessed post adenosine administration 20 minutes after ablation. Results In swine ventricular endocardial RF applications, use of 50W and 40W vs. 30W was associated with greater tissue lesion depth (5.06 ± 0.16 and 4.38 ± 0.13 mm vs. 3.95 ± 0.16 mm; P < 0.001) and smaller lesion maximum diameter (7.81 ± 0.15 and 8.42 ± 0.18 mm vs. 9.08 ± 0.15 mm; P < 0.001). Tissue necrosis caused by 50W vs. 40W and 30W was the deepest and largest (3.15 ± 0.18 mm vs. 2.71 ± 0.17 and 2.42 ± 0.13 mm; and 5.58 ± 0.18 mm vs. 5.18 ± 0.16 and 3.94 ± 0.17 mm; respectively; P < 0.001). In PVI, use of 40W vs. 30W was associated with shorter procedure time (56.54 ± 1.81 min vs. 76.55 ± 2.34 min; p < 0.001) and ablation time (35.85 ± 14.87 min vs. 51.01 ± 17.99 min; p < 0.001); lower RF energy per point (909.02 ± 354.57J vs. 1045 ± 376.60J; p < 0.001); higher first-pass PVI (87% vs. 72%; P < 0.01); lower acute PV reconnection (22% vs. 41%; P < 0.01); no complications in either group; and similar sinus rhythm maintenance at 12 months (92% vs. 84%; P = 0.22). Conclusions AI-guided high-power (40W) vs. conventional (30W) PVI was related to a reduced time for procedure and was considered safe, with diminished acute pulmonary vein reconnection.

scholarly journals High-power radiofrequency ablation guided by ablation index for pulmonary vein isolation

2020 ◽  
Author(s):  
xuefeng zhu ◽  
chunxiao wang ◽  
jianping li ◽  
wenjing li ◽  
hongxia chu ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Anterior Wall ◽  
Maximum Diameter ◽  
Ablation Index ◽  
Adenosine Administration ◽  
Rf Applications ◽  
Reduced Time ◽  
Posterior Anterior

Abstract Background: Proposed to facilitate pulmonary vein isolation (PVI), high-power ablation may cause extracardiac damage. This study evaluated the safety and efficacy of ablation index (AI) guided high-power ablation first in an animal model and subsequently in a clinical study.Methods:Outcomes of radiofrequency (RF) applications were compared in a swine ventricular endocardial model (n=10 each for 50W, 40W and 30W; AI=500), and in 100 consecutive patients with paroxysmal AF undergoing PVI (40W [last n=50] vs. 30 W [first n=50]; target AI=400/500 on posterior/anterior wall, respectively). Acute PV reconnection was assessed post adenosine administration 20 minutes after ablation.Results: In swine ventricular endocardial RF applications, use of 50W and 40W vs. 30W was associated with greater tissue lesion depth (5.06±0.16 and 4.38±0.13mm vs. 3.95±0.16mm; P<0.001) and smaller lesion maximum diameter (7.81±0.15 and 8.42±0.18mm vs. 9.08±0.15mm; P<0.001). Tissue necrosis caused by 50W vs. 40W and 30W was the deepest and largest (3.15±0.18mm vs. 2.71±0.17 and 2.42±0.13mm; and 5.58±0.18mm vs. 5.18±0.16 and 3.94±0.17mm; respectively; P<0.001). In PVI, use of 40W vs. 30W was associated with shorter procedure time (56.54±1.81min vs. 76.55±2.34min; p<0.001) and ablation time (35.85±14.87min vs. 51.01±17.99min; p<0.001); lower RF energy per point (909.02±354.57J vs. 1045±376.60J; p<0.001); higher first-pass PVI (87% vs. 72%; P<0.01); lower acute PV reconnection (22% vs. 41%; P<0.01); no complications in either group; and similar sinus rhythm maintenance at 12 months (92% vs. 84%; P=0.22).Conclusions: AI-guided high-power (40W) vs. conventional (30W) PVI was related to a reduced time for procedure and was considered safe, with diminished acute PV reconnection.

scholarly journals Procedural efficacy and safety of standardized, Ablation Index guided fixed 50W high power short duration pulmonary vein isolation and substrate modification using the CLOSE protocol

2021 ◽  
Author(s):  
Alexander Francke ◽  
Nadja Taha ◽  
Frank Scharfe ◽  
Steffen Schoen ◽  
Carsten Wunderlich ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Safety Data ◽  
Anterior Wall ◽  
Control Group ◽  
Complication Rates ◽  
Ablation Index ◽  
Procedural Time

Introduction: Ablation Index guided ablation according to the CLOSE protocol is very effective in terms of chronic pulmonary vein isolation (PVI). However, the optimal RF power remains controversial. Here, we thought to investigate the efficiency and safety of an AI guided fixed circumferential 50W high power short duration (HPSD) PVI using the CLOSE protocol Methods and results: In a single-centre prospective “proof of concept” trial 40 patients underwent randomized PVI using AI guided RF ablation without oesophageal temperature monitoring. In 20 patient fixed 50W HPSD was used irrespective to the anatomical localization. 20 subjects were ablated with standard power settings (20W posterior and 40W roof and anterior wall). Additionally, 80 consecutive patients were treated according to the HPSD protocol to gather additional safety data. All patients underwent post-procedural oesophago-gastro-duodenoscopy to reveal oesophageal lesions (EDEL). The mean total procedural time was 80.3±22.5 minutes in HPSD compared to control 109.1±27.4 (p<0.001). The total RF-time was significantly lower in HPSD 1379±505 sec vs. control 2374±619 sec (p<0.001).There were no differences in periprocedural complications. EDEL occurred in 13% in the HPSD and 10% in control group. EDEL occurring in the 50W HSDP patients were smaller, more superficial and had a faster healing tendency. Conclusions: A fixed 50W HPSD circumferential PVI relying to the ablation index and CLOSE protocol reduces the total procedure time and the total RF time compared to standard CLOSE protocol, without increasing the complication rates. The incidence of oesophageal lesions was similar using 50W at the posterior atrial wall.

P2841Atrial fibrillation ablation using ablation index guided high power (50W) smart touch technology for quantifiable and efficient circumferential pulmonary vein lesions (the FAFA power-touch study)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Chen ◽  
B Schmidt ◽  
S Bordignon ◽  
K R J Chun
Keyword(s):  
Pulmonary Vein ◽  
Contact Force ◽  
High Power ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Ablation Time ◽  
Ablation Index ◽  
The Mean ◽  
Power Point ◽  
A Minor

Abstract Background High-power short-duration ablation appears a promising concept. The so-called ablation index (AI) integrating power, contact force and time have demonstrated increased pulmonary vein isolation (PVI) durability. However, feasibility and safety of AI guided high-power ablation is unknown. Methods and results Symptomatic AF patients (n=50) underwent circumferential PVI using AI guided high-power point-by-point ablation (CARTO Smart-Touch). Ablation was set to 50W targeting AI values (550: anterior wall/roof, 400: posterior wall) with an inter-lesion distance of 6mm using a non-steerable sheath. An esophageal probe monitored luminal temperature rises (limit: 39°C). Acute PVI was obtained in all patients; first-pass efficacy was 92%. Mean ablation time per procedure was 11.2±2.2 min, mean procedure time was 55.6±6.6 min. A total of 2105 lesions were analyzed, comparing left anterior wall vs. left posterior wall and right anterior wall vs. right posterior wall, the mean ablation time (sec.) was 20.5±8.2 vs. 8.6±3.2, and 12.2±4 vs 9.3±3.4; the mean contact force (g): 17.1±12 vs 25.4±14.2 and 33.7±13.1 vs 21.0±10.5, the mean AI: 546.8±48.2 vs 444.6±55 and 554.8±56 vs. 439.8±47.1 (all P<0.0001). Audible steam pops were noted in in 4 (8%) patients. Esophageal temperature rise >39°C were noted in 25 (50%) patients. In 1/50 (2%) patient a minor esophageal lesion after ablation was observed without requiring specific therapy. No major complications such as death, stroke, tamponade or atria-esophageal -fistula occurred. Conclusion The novel AI guided high power ablation appears to be a feasible, safe, quantifiable and efficient strategy for PVI.

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