How much is enough? An appraisal of high‐power short‐duration radiofrequency ablation for pulmonary vein isolation

2019 ◽  
Vol 30 (11) ◽  
pp. 2205-2208
Author(s):  
Deep Chandh Raja ◽  
Prashanthan Sanders ◽  
Rajeev K. Pathak
Keyword(s):  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power

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

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.

Update on high‐power short‐duration ablation for pulmonary vein isolation

2020 ◽  
Vol 31 (9) ◽  
pp. 2499-2508 ◽  
Author(s):  
Jie Qiu ◽  
Yan Wang ◽  
Dao Wen Wang ◽  
Mei Hu ◽  
Guangzhi Chen
Keyword(s):  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power

High‐power and short‐duration ablation for pulmonary vein isolation: Safety, efficacy, and long‐term durability

2018 ◽  
Vol 29 (9) ◽  
pp. 1287-1296 ◽  
Author(s):  
Michael Barkagan ◽  
Fernando M. Contreras‐Valdes ◽  
Eran Leshem ◽  
Alfred E. Buxton ◽  
Hiroshi Nakagawa ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power

Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: short-term results of the POWER-FAST PILOT study

2019 ◽  
Vol 57 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Sergio Castrejón-Castrejón ◽  
Marcel Martínez Cossiani ◽  
Marta Ortega Molina ◽  
Carlos Escobar ◽  
Consuelo Froilán Torres ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Short Term

scholarly journals Pulmonary Vein Isolation With Very High Power, Short Duration, Temperature-Controlled Lesions

2019 ◽  
Vol 5 (7) ◽  
pp. 778-786 ◽  
Author(s):  
Vivek Y. Reddy ◽  
Massimo Grimaldi ◽  
Tom De Potter ◽  
Johan M. Vijgen ◽  
Alan Bulava ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Temperature Controlled ◽  
Very High

scholarly journals B-PO01-056 EFFICACY, SAFETY AND EFFICIENCY OF HIGH-POWER AND SHORT-DURATION ABLATION FOR PULMONARY VEIN ISOLATION

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S73-S74
Author(s):  
Vincenzo Schillaci ◽  
Giuseppe Stabile ◽  
Alberto Arestia ◽  
Alessia Agresta ◽  
Gergana Shopova ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power

Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation

EP Europace ◽  
2019 ◽  
Vol 22 (3) ◽  
pp. 388-393 ◽  
Author(s):  
Marc Kottmaier ◽  
Miruna Popa ◽  
Felix Bourier ◽  
Tilko Reents ◽  
Jairo Cifuentes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Short Duration ◽  
Pulmonary Vein Isolation ◽  
High Power ◽  
Paroxysmal Atrial Fibrillation ◽  
Pericardial Tamponade ◽  
Standard Group ◽  
Short Period ◽  
Procedural Time

Abstract Aims Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) in patients with paroxysmal atrial fibrillation (PAF) is effective but hampered by pulmonary vein reconnection due to insufficient ablation lesions. High-power delivery over a short period of time (HPSD) in RFA is stated to create more efficient lesions. The aim of this study was to compare intraprocedural safety and outcome of HPSD ablation to conventional power settings in patients undergoing PVI for PAF. Methods and results We included 197 patients with PAF that were scheduled for PVI. An ablation protocol with 70 W and a duration cut-off of 7 s at the anterior left atrium (LA) and 5 s at the posterior LA (HPSD group; n = 97) was compared to a conventional power protocol with 30–40 W for 20–40 s (standard group; n = 100) in terms of periprocedural complications and a 1-year outcome. The HPSD group showed significantly less arrhythmia recurrence during 1-year follow-up with 83.1% of patients free from atrial fibrillation compared to 65.1% in the standard group (P < 0.013). No pericardial tamponade, periprocedural thromboembolic complications, or atrio-oesophageal fistula occurred in either group. Mean radiofrequency time (12.4 ± 3.4 min vs. 35.6 ± 12.1 min) and procedural time (89.5 ± 23.9 min vs. 111.15 ± 27.9 min) were significantly shorter in the HPSD group compared to the standard group (both P < 0.001). Conclusion High-power short-duration ablation demonstrated a comparable safety profile to conventional ablation. High-power short-duration ablation using 70 W for 5–7 s leads to significantly less arrhythmia recurrences after 1 year. Radiofrequency and procedural time were significantly shortened.

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