A Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation

High power short duration versus low power long duration ablation in patients with atrial fibrillation: A meta‐analysis of randomized trials

“…Therefore, these studies suggest that, in addition to the contiguity of the lesions, their durability is also crucial for the success of ablation. 15 Indeed, shorter duration of delivery promotes catheter stability and contact force during respiratory acts, resulting in a reduction in the transient suppression of the electrical excitability of tissue oedema, leading to optimal and durable lesions. 5,30 There are concerns about the use of HPSD ablation and ischemic brain lesions.…”

“…In the studies included in our meta-analysis only one stroke occurred in the HPSD arm, but Short AF showed a nonsignificantly increased incidence of asymptomatic cerebral emboli (ACE). 15 These could be due to char, thrombus, steam pops or air/gas embolism from the RF lesion site and from manipulation of ablation devices, especially in high velocity saline/contrast injections. [31][32][33] An animal study by Takami et al showed that ablation with 50 W was more likely to produce microparticles in blood filters in an extracorporeal circulation loop than ablation with 30 W since it induced excessive heating of tissue and blood with a higher risk of coagulum formation.…”

“…9 HPSD has been demonstrated to produce larger, more superficial lesions that should not increase complication rate. 10,11 Nevertheless, trials showed conflicting results; specifically, Shin et al, 12 Power-AF 13 , and Pilot-AF 14 observed no significant differences between HPSD and low power long duration (LPLD) in contrast to the Short-AF 15 and Hi-Lo Heat 16 trials, regarding AF recurrences.…”

Compatibility of a novel temperature‐controlled, irrigated radiofrequency catheter with ultra‐high‐density mapping

“…We considered this compatibility relevant given the advantages of ultra-high-density mapping with the Rhythmia mapping system, and potential benefits of the accurate tiptissue interface temperature control of the DT, especially considering recent data showing a higher incidence of cerebral lesions with other catheters when used in high-power short-duration modes. [2][3][4][5][6] We hypothesized that following adequate configuration, the catheter would be accurately displayed on the mapping system, enabling precise lesion placement with no workflow impairment.…”

“…The aim of this study was to explore the safety and accuracy of this catheter when used under the guidance of the Rhythmia HDX mapping system (Boston Scientific) in patients undergoing macroreentrant atrial tachycardia (MRAT) ablation. We considered this compatibility relevant given the advantages of ultra‐high‐density mapping with the Rhythmia mapping system, and potential benefits of the accurate tip–tissue interface temperature control of the DT, especially considering recent data showing a higher incidence of cerebral lesions with other catheters when used in high‐power short‐duration modes 2–6 …”