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

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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Significance of Contact Force on Esophageal Thermal Injury During Relative High-Power Short-Duration Ablation of Atrial Fibrillation

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.121.009897 ◽

2021 ◽

Author(s):

Takashi Kaneshiro ◽

Kazuaki Amami ◽

Naoko Hijioka ◽

Minoru Nodera ◽

Shinya Yamada ◽

...

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

Contact Force ◽

High Power ◽

Thermal Injury

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Impact of High-Power Short-Duration Radiofrequency Ablation on Long-Term Lesion Durability for Atrial Fibrillation Ablation

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2020.04.023 ◽

2020 ◽

Vol 6 (8) ◽

pp. 973-985 ◽

Cited By ~ 3

Author(s):

Hagai D. Yavin ◽

Eran Leshem ◽

Ayelet Shapira-Daniels ◽

Jakub Sroubek ◽

Michael Barkagan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Short Duration ◽

High Power ◽

Atrial Fibrillation Ablation

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Comparison of high‐power short‐duration (HPSD) ablation of atrial fibrillation using a contact force‐sensing catheter and conventional technique: Initial results

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.14110 ◽

2019 ◽

Vol 30 (10) ◽

pp. 1877-1883 ◽

Cited By ~ 19

Author(s):

Fabricio Vassallo ◽

Christiano Cunha ◽

Eduardo Serpa ◽

Lucas Luis Meigre ◽

Hermes Carloni ◽

...

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

Contact Force ◽

High Power ◽

Conventional Technique ◽

Force Sensing ◽

Initial Results

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The impacts of contact force, power and application time on ablation effect indicated by serial measurements of impedance drop in both conventional and high-power short-duration ablation settings of atrial fibrillation

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-021-00990-4 ◽

2021 ◽

Author(s):

Li-Bin Shi ◽

Yu-Chuan Wang ◽

Song-Yun Chu ◽

Alessandro De Bortoli ◽

Peter Schuster ◽

...

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

Contact Force ◽

High Power ◽

Power Output ◽

Application Time ◽

Ablation Time ◽

Ablation Index ◽

Power Setting ◽

Power Outputs

Abstracts Background This study aimed to clarify the interrelationship and additive effects of contact force (CF), power and application time in both conventional and high-power short-duration (HPSD) settings. Methods Among 38 patients with paroxysmal atrial fibrillation who underwent first-time pulmonary vein isolation, 787 ablation points were collected at the beginning of the procedure at separate sites. Energy was applied for 60 s under power outputs of 25, 30 or 35 W (conventional group), or 10 s when using 50 W (HPSD group). An impedance drop (ID) of 10 Ω was regarded as a marker of adequate lesion formation. Results ID ≥ 10 Ω could not be achieved with CF < 5 g under any power setting. With CF ≥ 5 g, ID could be enhanced by increasing power output or prolonging ablation time. ID for 30 and 35 W was greater than for 25 W (p < 0.05). Ablation with 35 W resulted in greater ID than with 30 W only when CF of 10–20 g was applied for 20–40 s (p < 0.05). Under the same power output, ID increased with CF level at different time points. The higher the CF, the shorter the time needed to reach ID of 10 Ω and maximal ID. ID correlated well with ablation index under each power, except for lower ID values at 25 W. ID with 50 W for 10 s was equivalent to that with 25 W for 40 s, but lower than that with 30 W for 40 s or 35 W for 30 s. Conclusions CF of at least 5 g is required for adequate ablation effect. With CF ≥ 5g, CF, power output, and ablation time can compensate for each other. Time to reach maximal ablation effect can be shortened by increasing CF or power. The effect of HPSD ablation with 50 W for 10 s is equivalent to conventional ablation with 25 W for 40 s and 30–35 W for 20–30 s in terms of ID.

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