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

2020 ◽  
Vol 8 (4) ◽  
pp. 265-272 ◽  
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.

Proactive Esophageal Cooling Protects Against Thermal Insults During High-Power Short-Duration Radiofrequency Ablation

2021 ◽  
Author(s):  
Marcela Mercado-Montoya ◽  
Tatiana Gomez-Bustamante ◽  
Enrique Berjano ◽  
Steven Mickelsen ◽  
James Daniels ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Short Duration ◽  
High Power

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

2018 ◽  
Vol 29 (11) ◽  
pp. 1570-1575 ◽  
Author(s):  
Felix Bourier ◽  
Josselin Duchateau ◽  
Konstantinos Vlachos ◽  
Anna Lam ◽  
Claire A. Martin ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Short Duration ◽  
High Power

Prediction of radiofrequency ablation lesion formation using a novel temperature sensing technology incorporated in a force sensing catheter

Heart Rhythm ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 248-254 ◽  
Author(s):  
Guy Rozen ◽  
Leon Ptaszek ◽  
Israel Zilberman ◽  
Kevin Cordaro ◽  
E. Kevin Heist ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Temperature Sensing ◽  
Force Sensing ◽  
Ablation Lesion ◽  
Lesion Formation ◽  
Sensing Technology

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

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.

scholarly journals Efficacy and safety of 50-60 Watt high-power short-duration radiofrequency catheter ablation of atrial fibrillation: A propensity score matching study

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
HN Pak ◽  
SY Yang ◽  
M Kim ◽  
HT Yu ◽  
TH Kim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Short Duration ◽  
High Power ◽  
Volume Index ◽  
Ablation Lesion ◽  
Efficacy And Safety ◽  
Clinical Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although high-power short-duration (HPSD) radiofrequency (RF) energy is commonly utilized in atrial fibrillation (AF) catheter ablation (CA), its efficacy, safety, and autonomic neural effects have not yet been evaluated in a large patient number. We compared HPSD-AFCA and conventional power (ConvP)-AFCA after propensity score matching. Methods Among 3,221 consecutive AF ablation patients, we included 1,720 patients (74.4% male, 59 ± 10 years old, 56.5% paroxysmal type) who underwent AFCA after propensity score matching: 430 in 50∼60W HPSD group vs. 1,290 in the ConvP group. We evaluated the procedural factors, complication risk, rhythm outcome, and 3-month heart rate variability (HRV) between the two groups and subgroups. Results Procedure times were significantly shorter in the HPSD group (p < 0.001), but the complication rate (p = 0.088) and the 3rd-month HRV did not differ between the two groups. At the 12-month follow-up, rhythm outcomes did not differ between the two groups (Overall, Log-rank p = 0.212; anti-arrhythmic drug off Log rank p = 0.246). These efficacy and safety outcomes were consistently similar regardless of the AF type or ablation lesion set. In the Cox regression analysis, the left atrium volume index measured by computed tomography (HR 1.009 [1.003-1.015]), p = 0.005) and extra-pulmonary vein triggers (HR 1.587 [1.033-2.440], p = 0.035) were independently associated with 1-year clinical recurrence, while the HPSD strategy was not (HR 1.188 [0.903-1.564], p = 0.218). Conclusions HPSD-AFCA significantly shortened the procedure time with similar rhythm outcomes, complication risks, and autonomic neural effects as ConvP-AFCA, regardless of the AF type or ablation lesion set. Abstract Figure.

scholarly journals Real-time photoacoustic assessment of radiofrequency ablation lesion formation in the left atrium

2019 ◽  
Vol 16 ◽  
pp. 100150 ◽  
Author(s):  
Sophinese Iskander-Rizk ◽  
Pieter Kruizinga ◽  
Robert Beurskens ◽  
Geert Springeling ◽  
Frits Mastik ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Left Atrium ◽  
Real Time ◽  
Ablation Lesion ◽  
Lesion Formation

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.

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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