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

Yamaguchi, Junji; Takigawa, Masateru; Goya, Masahiko; Martin, Claire; Yamamoto, Tasuku; Ikenouchi, Takashi; Shigeta, Takatoshi; Nishimura, Takuro; Tao, Susumu; Miyazaki, Shinsuke; Sasano, Tetsuo

doi:10.1111/jce.15875

Cited by 15 publications

(15 citation statements)

References 19 publications

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“…Additional variables for lesion creation that were systematically evaluated include contact force (CF), temperature limit, and catheter orientation. 10 The primary analysis evaluated lesion size (depth, volume) and surface areas as well as rates of steam pop. DRA resulted in the deepest and largest lesions followed by DNRA then SA (depth: 3.8 mm vs 3.3 mm vs 2.6 mm; volume: 177 mm 3 vs 145 mm 3 vs 97 mm 3 , respectively).…”

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confidence: 99%

“…In the double application group (DRA and DNRA arms combined), the authors found that lesions made with the DRA approach and, counterintuitively, CF< 15g were found to be significant predictors of steam pop by both univariate and multivariate analyses. 10 Traditionally, higher contact forces have been associated with increased risk of steam pop with conventional and HPSD RF ablations. 11 Presumably, lower contact force during vHPSD ablation results in less robust ascertainment of tissue temperature and thus a lower ability to reduce power in response to significant tissue heating.…”

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confidence: 99%

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Very High Power Short Duration Ablation: It Takes Two to Make a Thing Go Right?

Maidman

Barbhaiya

2023

Preprint

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High power short duration (HPSD) radiofrequency (RF) ablation, utilizing 45-50W for durations of 5-15 seconds per lesion, is increasingly accepted as a safe and effective technique to efficiently achieve pulmonary vein isolation to prevent atrial fibrillation (AF). 1 The next contender in the progression of hotter and faster RF technology is very high power short duration (vHPSD) RF ablation -90W power for a duration of 4 seconds per lesion -using the QDOT-Micro ablation catheter (Biosense Webster, CA, USA). The catheter is designed to mitigate risks of vHPSD RF ablation by monitoring temperature at the catheter-tissue interface using six thermocouples embedded in the electrode's tip which allows for power modulation to maintain a target temperature during RF delivery. 2 Relative to HPSD ablation utilizing 45-50W, vHPSD ablation with 90W may further maximize shallow, resistive heating, while the shorter duration may additionally minimize deep, conductive heating. [2][3][4] The frequency and risk factors for the feared complications related to ablation, like steam pop, cardiac perforation, or esophageal injury, are not well understood for vHPSD. 5 Early clinical studies of vHPSD ablation reported first pass PVI in approximately 50% of cases, while first pass PVI was achieved in greater frequency with both conventional and HPSD RF ablation using recently described approaches such as the "CLOSE Protocol". [5][6][7] First pass isolation has been shown to be a powerful predictor of procedural efficacy, 3,8,9 thus a greater understanding of the underlying biophysics of lesions created with vHPSD RF ablation may inform optimization of timing and spacing to further improve outcomes for this new technology.

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confidence: 99%

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confidence: 99%

Very High Power Short Duration Ablation: It Takes Two to Make a Thing Go Right?

Maidman

Barbhaiya

2023

Preprint

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“…In this issue of the Journal, Yamaguchi and colleagues 10 undertook a detailed analysis of 480 RF ablation lesions created with the QDOT‐Micro ablation catheter at 90 W over 4 s in an in‐vitro porcine myocardial model. They attempted to better elucidate the biophysics of single and multiple point‐by‐point RF ablation applications to inform creation of lesion sets using a vHPSD approach.…”

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confidence: 99%

“…Single application (SA) vHPSD ablation was compared to double repetitive application (DRA), in which a second vHPSD RF application was performed as soon as the mandatory 4 s RF lockout expired, and double nonrepetitive RF application (DNRA), in which a second RF application was performed approximately 1 min after initial ablation. Additional variables for lesion creation that were systematically evaluated include contact force (CF), temperature limit, and catheter orientation 10 …”

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Very high power short duration ablation: It takes two to make a thing go right?

Maidman¹,

Barbhaiya²

2023

Cardiovasc electrophysiol

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An optimized approach for increasing lesion size in temperature‐controled setting using a catheter with a surface thermocouple and efficient irrigation

Takigawa,

Yamaguchi,

Goya

et al. 2024

Journal of Arrhythmia

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BackgroundWe explore an optimized approach for increasing lesion size using a novel ablation catheter with a surface thermocouple and efficient irrigation in a temperature‐control setting.MethodsWe conducted radiofrequency applications at various power levels (35 W, 40 W, and 45 W), contact forces (CFs, 10 g/20 g), and durations (60 s/120 s/180 s) in perpendicular/parallel catheter orientations, with normal saline irrigation (NS‐irrigation) and Half NS‐irrigation (HNS‐irrigation) in an ex‐vivo model (Step 1). In addition, we performed applications (35 W/40 W/45 W for 60 s/120 s/180 s in NS‐irrigation and 35 W/40 W for 60 s/120 s/180 s in HNS‐irrigation) in four swine (Step 2), evaluating lesion characteristics and the occurrence of steam pops.ResultsIn Step 1, out of 288 lesions, we observed 47 (16.3%) steam pops, with 13 in NS‐irrigation and 34 in HNS‐irrigation (p = .001). Although steam pops were mostly observed with the most aggressive setting (45 W/180 s, 54%) with NS‐irrigation, they happened in less aggressive settings with HNS irrigation. Lesion size significantly increased with longer‐duration ablation but not with HNS‐irrigation. The optimal %impedance‐drop cutoff to predict steam pops was 20% with a negative‐predictive‐value (NPV) = 95.1% including NS‐ and HNS‐irrigation groups, and 22% with an NPV = 96.1% in NS‐irrigation group. In Step 2, similar to the ex‐vivo model, lesion size significantly increased with longer‐duration ablation but not with HNS‐irrigation. Steam pops were absent with NS‐irrigation (0/35) even with the largest %impedance‐drop reaching 31% at 45 W/180 s. All steam pops were observed with HNS‐irrigation (6/21, 29%). The optimal %impedance‐drop cutoff predicting steam pops was 24% with an NPV = 96.3% including both NS‐ and HNS‐irrigation groups.ConclusionsRather than using HNS‐irrigation, very long‐duration of radiofrequency applications up to 45 W/180 s may be recommended to safely and effectively increase lesion dimensions using this catheter with NS‐irrigation.

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

Cited by 15 publications

References 19 publications

Very High Power Short Duration Ablation: It Takes Two to Make a Thing Go Right?

Very High Power Short Duration Ablation: It Takes Two to Make a Thing Go Right?

Very high power short duration ablation: It takes two to make a thing go right?

An optimized approach for increasing lesion size in temperature‐controled setting using a catheter with a surface thermocouple and efficient irrigation

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