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

Publisher: Blackwell Country of Publication: United States NLM ID: 9010756 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1540-8167 (Electronic) Linking ISSN: 10453873 NLM ISO Abbreviation: J Cardiovasc Electrophysiol Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Mt. Kisco, N.Y. : Futura Pub., c1990-

Catheter Ablation/*instrumentation ; Catheter Ablation/*methods ; Pulmonary Veins/*surgery; Animals ; Atrial Fibrillation/physiopathology ; Atrial Fibrillation/surgery ; Heart Atria/physiopathology ; Heart Atria/surgery ; Heart Conduction System/physiopathology ; Swine ; Time Factors ; Treatment Outcome

Introduction: PV reconnection is often the result of catheter instability and tissue edema. High-power short-duration (HP-SD) ablation strategies have been shown to improve atrial linear continuity in acute pre-clinical models. This study compares the safety, efficacy, and long-term durability of HP-SD ablation with conventional ablation.
Methods and Results: In 6 swine, 2 ablation lines were performed anterior and posterior to the crista terminalis, in the smooth and trabeculated right atrium, respectively; and the right superior PV was isolated. In 3 swine, ablation was performed using conventional parameters (Thermocool-Smarttouch ^® SF; 30 W/30 seconds) and in 3 other swine using HP-SD parameters (QDOT-MICRO™, 90 W/4 seconds). After 30 days, linear integrity was examined by voltage mapping and pacing, and the heart and surrounding tissues were examined by histopathology. Acute line integrity was achieved with both ablation strategies; however, HP-SD ablation required 80% less RF time compared with conventional ablation (P ≤ 0.01 for all lines). Chronic line integrity was higher with HP-SD ablation: all 3 posterior lines were continuous and transmural compared to only 1 line created by conventional ablation. In the trabeculated tissue, HP-SD ablation lesions were wider and of similar depth with 1 of 3 lines being continuous compared to 0 of 3 using conventional ablation. Chronic PVI without stenosis was evident in both groups. There were no steam-pops. Pleural markings were present in both strategies, but parenchymal lung injury was only evident with conventional ablation.
Conclusions: HP-SD ablation strategy results in improved linear continuity, shorter ablation time, and a safety profile comparable to conventional ablation.
(© 2018 Wiley Periodicals, Inc.)

Keywords: catheter ablation; pulmonary vein isolation; radiofrequency energy; right atrium

Date Created: 20180531 Date Completed: 20191108 Latest Revision: 20191108

20240829

10.1111/jce.13651

29846987