Efficiency, Safety, and Efficacy of High-Power Short-Duration Radiofrequency Ablation in Patients with Atrial Fibrillation

Sun, Xuerong; Jiang, Lu; Lin, Jinxuan; Feng, Tianjie; Suo, Ni; Zheng, Lihui; Liu, Zhimin; Chen, Gang; Fan, Xiaohan; Zhang, Shu; Niu, Guodong

doi:10.1155/2021/8821467

Cited by 7 publications

(8 citation statements)

References 41 publications

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“…FPI was achieved in 35.0% in the “5–6 mm” group and 90.9% in the “3–4 mm” group ( p < 0.0001) ( 19 ). In our present study, we used ILD < 6 mm both in LPLD and HPSD (50 W) groups, and according to our findings, HPSD ablation improves the chance of creating a contiguous lesion set, probably due to wider RF ablation lesions, which seem to increase the FPI rate by boosting the continuity of the circumferential lesions ( 33 ). Of note, lesion size might be smaller in case of vHPSD ( 34 ).…”

Section: Discussionmentioning

confidence: 84%

Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation

Salló

Perge

Balogi

et al. 2022

Front. Cardiovasc. Med.

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IntroductionHigh-power short-duration (HPSD) radiofrequency ablation has been proposed to produce rapid and effective lesions for pulmonary vein isolation (PVI). We aimed to evaluate the procedural characteristics and the first-pass isolation (FPI) rate of HPSD and very high-power short-duration (vHPSD) ablation compared to the low-power long-duration (LPLD) ablation technique.MethodsOne hundred fifty-six patients with atrial fibrillation (AF) were enrolled and assigned to LPLD, HPSD, or vHPSD PVI. The energy setting was 30, 50, and 90 W in the LPLD, HPSD, and vHPSD groups, respectively. In the vHPSD group, 90 W/4 s energy delivery was used in the QMODE+ setting. In the other groups, ablation index-guided applications were delivered with 30 W (LPLD) or 50 W (HPSD).ResultsBilateral PVI was achieved in all cases. Compared to the LPLD group, the HPSD and vHPSD groups had shorter procedure time [85 (75–101) min, 79 (65–91) min, and 70 (53–83) min], left atrial dwelling time [61 (55–70) min, 53 (41–56) min, and 45 (34–52) min], total RF time [1,567 (1,366–1,761) s, 1,398 (1,021–1,711) s, and 336 (247–386) s], but higher bilateral FPI rate (57, 78, and 80%) (all p-values < 0.01). The use of HPSD (OR = 2.72, 95% CI 1.15–6.44, p = 0.023) and vHPSD (OR = 2.90, 95% CI 1.24–6.44, p = 0.014) ablation techniques were associated with a higher probability of bilateral FPI. The 9-month AF-recurrence rate was lower in case of HPSD and vHPSD compared to LPLD ablation (10, 8, and 36%, p = 0.0001). Moreover, the presence of FPI was associated with a lower AF-recurrence rate at 9-month (OR = 0.09, 95% CI 0.04–0.24, p = 0.0001).ConclusionOur prospective, observational cohort study showed that both HPSD and vHPSD RF ablation shortens procedure and RF time and results in a higher rate of FPI compared to LPLD ablation. Moreover, the use of HPSD and vHPSD ablation increased the acute and mid-term success rate. No safety concerns were raised for HPSD or vHPSD ablation in our study.

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Section: Discussionmentioning

confidence: 84%

Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation

Salló

Perge

Balogi

et al. 2022

Front. Cardiovasc. Med.

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“…While conventional settings during RF ablation involve applying low power for long times, a new setting based on high power and short duration has recently been suggested as safer and more effective 33–36 . Overall, high‐power short‐duration lesions were significantly wider, and of slightly lower or similar depth compared to standard settings 33 .…”

Section: Discussionmentioning

confidence: 99%

Robotic magnetic navigation‐guided catheter ablation establishes highly effective pulmonary vein isolation in patients with paroxysmal atrial fibrillation when compared to conventional ablation techniques

Noten,

Romanov,

De Schouwer

et al. 2023

Cardiovasc electrophysiol

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IntroductionPulmonary vein isolation (PVI) is a pivotal part of ablative therapy for atrial fibrillation (AF). Currently, there are multiple techniques available to realize PVI, including: manual‐guided cryoballoon (MAN‐CB), manual‐guided radiofrequency (MAN‐RF), and robotic magnetic navigation‐guided radiofrequency ablation (RMN‐RF). There is a lack of large prospective trials comparing contemporary RMN‐RF with the more conventional ablation techniques. This study prospectively compared three catheter ablation techniques as treatment of paroxysmal AF.MethodsThis multicenter, prospective study included patients with paroxysmal AF who underwent their first ablation procedure. Procedural parameters (including procedural efficiency), complication rates, and freedom of AF during 12‐month follow‐up, were compared between three study groups which were defined by the utilized ablation technique.ResultsA total of 221 patients were included in this study. Total procedure time was significantly shorter in MAN‐CB (78 ± 21 min) compared to MAN‐RF (115 ± 41 min; p < .001) and compared to RMN‐RF (129 ± 32 min; p < .001), whereas it was comparable between the two radiofrequency (RF) groups (p = .062). A 3% complication rate was observed, which was comparable between all groups. At 12‐month follow‐up, AF recurrence was observed in 40 patients (19%) and was significantly lower in the robotic group (MAN‐CB 19 [24%], MAN‐RF 16 [23%], RMN‐RF 5 [8%] AF recurrences, p = .045) (multivariate hazard ratio of RMN‐RF on AF recurrence 0.32, 95% confidence interval: 0.12–0.87, p = .026).ConclusionRMN‐guided PVI results in high freedom of AF in patients with paroxysmal AF, when compared to cryoablation and manual RF ablation. Cryoablation remains the most time‐efficient ablation technique, whereas RMN nowadays has comparable efficiency with manual RF ablation.

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“…Although HPSD ablation is increasing in epidemic management strategies for patients with AF, the narrow efficacy and safety window of HPSD ablation should be recognized. 9 LSI is calculated by integrating the power, CF, impedance, and time, which can accurately predict lesion dimensions in an experimental study and is commonly used as a real-time surrogate to guide RF duration and predict lesion size. 11,14,15 Compared with LP ablation, HP ablation requires a shorter RF duration to achieve a prespecified LSI.…”

Section: Clinical Outcomementioning

confidence: 99%

“…2,3 Although a series of clinical studies have revealed that HPSD ablation is feasible and effective for achieving a high rate of first-pass PVI and reducing procedure complications, [4][5][6][7][8] the longterm efficacy of this strategy remains undefined. 9 Moreover, a novel proprietary index, the lesion size index (LSI), incorporating power, contact force (CF), impedance, and time, has been used as a real-time surrogate to guide RF duration and has been found to be highly predictive of RF lesion dimension, and lower LSI values are associated with a higher risk of AF recurrence. [10][11][12][13] Although recently published data have revealed that LSI-guided HP ablation for PVI could help manage RF duration and improve durable and transmural lesions, 14,15 the long-term impact of LSI-guided HP ablation for PVI in patients is still unclear.…”

Section: Introductionmentioning

confidence: 99%

“…Compared with traditional low‐power long‐duration (LPLD) ablation (20–30 W), recent emerging high‐power short‐duration (HPSD) ablation (45 W or higher) may generate predominantly direct resistive heating while minimizing conductive heating, creating a larger diameter and lesser depth with similar lesion volumes, which can result in fewer conduction gaps and reduce the risk of collateral damage to adjacent structures such as the esophagus 2,3 . Although a series of clinical studies have revealed that HPSD ablation is feasible and effective for achieving a high rate of first‐pass PVI and reducing procedure complications, 4–8 the long‐term efficacy of this strategy remains undefined 9 . Moreover, a novel proprietary index, the lesion size index (LSI), incorporating power, contact force (CF), impedance, and time, has been used as a real‐time surrogate to guide RF duration and has been found to be highly predictive of RF lesion dimension, and lower LSI values are associated with a higher risk of AF recurrence 10–13 .…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcome of lesion size index‐guided high‐power radiofrequency catheter ablation for pulmonary vein isolation in patients with atrial fibrillation: 2‐year follow‐up

Cai

Wang

Niu

et al. 2023

Cardiovasc electrophysiol

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Introduction: The long-term efficacy of high-power (50 W) ablation guided by lesion size index (LSI-guided HP) for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) remains undetermined. Our study sought to assess the clinical efficacy of LSI-guided HP ablation for PVI in patients with AF and explore the potential predictors associated with clinical outcomes. Methods: We consecutively included 186 patients with AF who underwent LSI-guided HP (50 W) ablation at Fuwai Hospital from June 2019 to October 2021. The target LSI values of 4.5-5.5 and 4.0-4.5 at the anterior and posterior walls, respectively, were used in our study. The baseline clinical characteristics, procedural and ablation data, and clinical outcomes were evaluated. The independent potential predictors associated with AF recurrence were further evaluated. Results:The incidence rate of first-pass PVI was 83.9% (156/186). A total of 11 883 lesions were analyzed, and compared with posterior walls of pulmonary veins, anterior walls had significantly lower mean contact force (8.2 ± 3.0 vs. 8.3 ± 2.3 g, p = .015), longer mean radiofrequency duration (16.9 ± 7.2 vs. 12.9 ± 4.5 s, p < .001) and higher mean LSI (4.8 ± 0.2 vs. 4.4 ± 0.2, p < .001). The overall incidence of periprocedural complications was 3.7%, and steam pops without pericardial effusion occurred in three patients (1.6%). During a mean follow-up of 24.0 ± 8.4 months, the overall AF recurrence-free survival was 87.1% after a single procedure. Patients with paroxysmal AF had a higher incidence of freedom from AF recurrence than those with persistent AF (91.2% vs. 80.8%, log-rank p = .034). Higher LSI (HR 0.50, p < .001) and paroxysmal AF (HR 0.39, p = .029) were significantly associated with decreased AF recurrence. By receiver operating characteristic analysis, the LSI of 4.7 and 4.3 for the anterior and posterior walls of the PVs had the highest predictive value for AF recurrence, respectively. Conclusion: LSI-guided HP (50 W) ablation for PVI was an efficient and safe strategy and led to favorable single-procedure 2-year AF recurrence-free survival in patients with AF. Higher LSI and paroxysmal AF were independent predictors of decreased

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Efficiency, Safety, and Efficacy of High-Power Short-Duration Radiofrequency Ablation in Patients with Atrial Fibrillation

Cited by 7 publications

References 41 publications

Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation

Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation

Robotic magnetic navigation‐guided catheter ablation establishes highly effective pulmonary vein isolation in patients with paroxysmal atrial fibrillation when compared to conventional ablation techniques

Clinical outcome of lesion size index‐guided high‐power radiofrequency catheter ablation for pulmonary vein isolation in patients with atrial fibrillation: 2‐year follow‐up

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