Characteristics of Very High-Power, Short-Duration Radiofrequency Applications

Orbán, Gábor; Salló, Zoltán; Perge, Péter; Ábrahám, Pál; Piros, Katalin; Nagy, Klaudia Vivien; Osztheimer, István; Merkely, Béla; Gellér, László; Szegedi, Nándor

doi:10.3389/fcvm.2022.941434

Cited by 8 publications

(11 citation statements)

References 34 publications

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“…The present study demonstrated that steam‐pops were observed in 4.4% of SA approach. However, clinical trials of 90 W/4 s ablation using the QDOT‐MICRO™ catheter described a lower rate of steam‐pops (=0%) than in this study 3,9,14,18 . In the present un‐perfused ex vivo model without cardiac and respiratory movement, steam‐pop risks might be overestimated, 19 and lesion characteristics might be different from those in a clinical setting.…”

Section: Discussioncontrasting

confidence: 69%

“…However, clinical trials of 90 W/4 s ablation using the QDOT-MICRO™ catheter described a lower rate of steam-pops (=0%) than in this study. 3,9,14,18 In the present un-perfused ex vivo model without cardiac and respiratory movement, steam-pop risks might be overestimated, 19 and lesion characteristics might be different from those in a clinical setting. In the present study, the number of steam-pops was relatively low especially for SAs.…”

Section: Limitationsmentioning

confidence: 77%

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Comparison of three different approaches to very high‐power short‐duration ablation using the QDOT‐MICRO catheter

Yamaguchi

Takigawa

Goya

et al. 2023

Cardiovasc electrophysiol

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Background/Objectives The QDOT‐MICRO™ catheter allows very high‐power and short‐duration (vHPSD) ablation. This study aimed to investigate lesion characteristics using different ablation settings. Methods Radiofrequency applications (90 W/4 s, temperature‐control mode with 55°C or 60°C target) were performed in excised porcine myocardium using three different approaches: single (SA), double nonrepetitive (DNRA), and double repetitive applications (DRA). Applications were performed with an interval of 1 min for DNRA, and without interval for DRA. Results A total of 480 lesions were analyzed. Lesion depth and volume were largest for DRA followed by DNRA and SA regardless of catheter direction (depth: 3.8 vs. 3.3 vs. 2.6 mm, p < .001 for all comparisons; volume: 176.6 vs. 145.1 vs. 97.0 mm3, p < .001 for all comparisons). Surface area was significantly larger for DRA than for SA (45.1 vs. 38.3 mm2, p < .001) and larger for DNRA than for SA (44.5 vs. 38.3 mm2, p < .001), but was similar between DRA and DNRA (45.1 vs. 44.5 mm2, p = .54). Steam‐pops more frequently occurred for DRA than for SA (15.6% vs. 4.4%, p = .004) and DNRA (15.6% vs. 6.9%, p = .061), but the incidence was similar between SA and DNRA (4.4% vs. 6.9%, p = 1). Although surface area and lesion volume were larger in lesions with steam‐pops than without steam‐pops (46.5 vs. 38.1 mm2, p = .018 and 128.3 vs. 96.8 mm3, p = .068, respectively), lesions were not deeper (pop(+): 2.5 mm vs. pop(−): 2.6 mm, p = .75). Conclusions DNRA produces larger lesions than SA without increasing the risk of steam‐pops. DRA produces the largest lesions among the three groups, but with an increased risk of steam‐pops. Even with steam‐pops, lesions do not become deeper in vHPSD ablation.

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Section: Discussioncontrasting

confidence: 69%

Section: Limitationsmentioning

confidence: 77%

Comparison of three different approaches to very high‐power short‐duration ablation using the QDOT‐MICRO catheter

Yamaguchi

Takigawa

Goya

et al. 2023

Cardiovasc electrophysiol

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“…The vHPSD strategy aims to create shallower but wider lesions in a very short time by reducing conductive heating and increasing resistive heating at the same time. Additionally, collateral tissue damage might be reduced 28,31 …”

Section: Introductionmentioning

confidence: 99%

Very high‐power short‐duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series

Heeger,

Kuck,

Tilz

2023

Cardiovasc electrophysiol

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The QDOT MICRO™ Catheter is a novel open‐irrigated contact force‐sensing radiofrequency ablation catheter. It offers very high‐power short‐duration (vHPSD) ablation with 90 W for 4 s to improve safety and efficacy of catheter ablation procedures. Although the QDOT MICRO™ Catheter was mainly designed for pulmonary vein isolation (PVI) its versatility to treat atrial fibrillation (AF) and other types of arrhythmias was recently evaluated by the FAST and FURIOUS study series and other studies and will be presented in this article. Available study and registry data as well as case reports concerning utilization of the QDOT MICRO™ Catheter for the treatment of cardiac arrhythmias including AF, focal and macroreentry atrial tachycardia, typical atrial flutter by cavotricuspid isthmus block, premature ventricular contractions, and accessory pathways were reviewed and summarized. In summary, the QDOT MICRO™ Catheter showed safety and efficacy for PVI and is able to treat also other types of arrhythmias as is was recently evaluated by case reports and the FAST and FURIOUS studies.

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“…[5][6][7][8][9] Recently, a very HPSD (vHPSD; 90 W, 4 s) technique has been introduced, but initial efficacy results were mostly discouraging regarding first-pass isolation rates, acute reconnection rates, and arrhythmia-free survival. [10][11][12][13][14] We hypothesized that vHPSD PVI could result in similar acute and long-term efficacy as ablation indexguided PVI with 50 W. 11 Therefore, we designed the HPSD Remap study (Efficacy Comparison of High and Very High Power Short Duration Pulmonary Vein Isolation, URL: https://www.clinicaltrials.gov; unique identifier NCT05459831), in which durability of lesions was assessed by a repeat electrophysiology study after an index PVI performed with either a 90-or 50-W power setting.…”

mentioning

confidence: 99%

“…5–9 Recently, a very HPSD (vHPSD; 90 W, 4 s) technique has been introduced, but initial efficacy results were mostly discouraging regarding first-pass isolation rates, acute reconnection rates, and arrhythmia-free survival. 10–14…”

mentioning

confidence: 99%

Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study

Szegedi,

Salló,

Nagy

et al. 2024

Circ: Arrhythmia and Electrophysiology

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BACKGROUND: High-power short-duration ablation has shown impressive efficacy and safety for pulmonary vein isolation (PVI); however, initial efficacy results with very high power short-duration ablation were discouraging. This study compared the long-term durability of PVI performed with a 90 versus 50 W power setting. METHODS: Patients were randomized 1:1 to undergo PVI with the QDOT catheter using a power setting of 90 or 50 W. Three months after the index procedure, patients underwent a repeat electrophysiology study to identify pulmonary vein reconnections. Patients were followed for 12 months to detect AF recurrences. RESULTS: We included 46 patients (mean age, 64 years; female, 48%). Procedure (76 versus 84 minutes; P =0.02), left atrial dwell (63 versus 71 minutes; P =0.01), and radiofrequency (303 versus 1040 seconds; P <0.0001) times were shorter with 90W versus 50W procedures, while the number of radiofrequency applications was higher with 90W versus 50W (77 versus 67; P =0.01). There was no difference in first-pass isolation (83% versus 82%; P =1.0) or acute reconnection (4% versus 14%; P =0.3) rates between 90W and 50W. Forty patients underwent a repeat electrophysiology study. Durable PVI on a per PV basis was present in 72/78 (92%) versus 68/77 (88%) PVs in the 90W and 50W energy setting groups, respectively; effect size: 72/78−68/77=0.040, lower 95% CI=−0.051 (noninferiority limit=−0.1, ie, noninferiority is met). No complications occurred. There was no difference in 12-month atrial fibrillation-free survival between the 90W and 50W groups ( P =0.2). CONCLUSIONS: Similarly high rates of durable PVI and arrhythmia-free survival were achieved with 90W and 50W. Procedure, left atrial dwell, and radiofrequency times were shorter with 90W compared with 50W. The sample size is too small to conclude the safety and long-term efficacy of the high and very high-power short-duration PVI; further studies are needed to address this topic. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05459831.

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Characteristics of Very High-Power, Short-Duration Radiofrequency Applications

Cited by 8 publications

References 34 publications

Comparison of three different approaches to very high‐power short‐duration ablation using the QDOT‐MICRO catheter

Comparison of three different approaches to very high‐power short‐duration ablation using the QDOT‐MICRO catheter

Very high‐power short‐duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series

Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study

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