High-power short-duration catheter ablation of atrial fibrillation: is it really a new era? Comparison between new and old radiofrequency contact force–sensing catheters

Russo, Antonio Dello; D’Angelo, Leonardo; Compagnucci, Paolo; Cipolletta, Laura; Parisi, Quintino; Valeri, Yari; Campanelli, Francesca; Volpato, Giovanni; Carboni, Laura; Ciliberti, Giuseppe; Stronati, Giulia; Barbarossa, Alessandro; Piscopia, Valentina La; Bondavalli, Barbara; Guerra, Federico; Casella, Michela

doi:10.1007/s10840-023-01612-x

Cited by 10 publications

(5 citation statements)

References 31 publications

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“…Use of higher power and irrigation settings may allow uniform and predictable ablation, 19 via maximization of the diameter/depth ratio of individual ablation lesions, which may be especially desirable in thinner atrial regions and/or near the esophagus. 19 , 20 , 21 The larger-diameter ablation lesions produced by vHPSD applications may also explain our finding of a larger PW ablation area in the vHPSD group despite a similar number of VisiTags TM (Biosense Webster). 19 …”

Section: Discussionmentioning

confidence: 80%

Posterior wall ablation for persistent atrial fibrillation: Very-high-power short-duration versus standard-power radiofrequency ablation

Compagnucci,

Volpato,

Cipolletta

et al. 2024

Heart Rhythm O2

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Section: Discussionmentioning

confidence: 80%

Posterior wall ablation for persistent atrial fibrillation: Very-high-power short-duration versus standard-power radiofrequency ablation

Compagnucci,

Volpato,

Cipolletta

et al. 2024

Heart Rhythm O2

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“…For PVI, 10 s may suffice for thinner segments, while up to 20 s may be necessary for thicker segments. Clinical studies have demonstrated the efficacy and safety of applying 40−50 W for 10−20 s using TactiFlex in a clinical setting 19 . Even for deeper lesions with this catheter, applications of up to 7000 J have been safely performed, as shown in Figure 4.…”

Section: Discussionmentioning

confidence: 97%

“…However, when high‐power ablation at 50 W is applied using TactiFlex, it can create lesions approximately 2–3 mm in depth in 10 s (500 J) and 3–5 mm in depth in 20 s (1000 J) 19,20 . For PVI, 10 s may suffice for thinner segments, while up to 20 s may be necessary for thicker segments.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical studies have demonstrated the efficacy and safety of applying 40−50 W for 10−20 s using TactiFlex in a clinical setting. 19 Even for deeper lesions with this catheter, applications of up to 7000 J have been safely performed, as shown in Figure 4. This demonstration highlights the safety of the TactiFlex catheter, provided that we closely monitor impedance drop, as detailed in this study.…”

Section: Comparison To the Other Catheter Used With Temperature-contr...mentioning

confidence: 96%

“…However, when high-power ablation at 50 W is applied using Tac-tiFlex, it can create lesions approximately 2-3 mm in depth in 10 s (500 J) and 3-5 mm in depth in 20 s (1000 J). 19,20 For PVI, 10 s may suffice for thinner segments, while up to 20 s may be necessary for thicker segments. Clinical studies have demonstrated the efficacy and safety of applying 40−50 W for 10−20 s using TactiFlex in a clinical setting.…”

Section: Comparison To the Other Catheter Used With Temperature-contr...mentioning

confidence: 99%

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Safety verification of a novel irrigation catheter with flexible tip of laser‐cut kerfs and contact force sensor

Yamaguchi,

Takigawa,

Goya

et al. 2023

Pacing Clinical Electrophis

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Background and aimsThe safety evaluation of TactiFlex, a novel contact‐force sensing catheter with a flexible 4‐mm tip irrigated through laser‐cut kerfs, has been ongoing. This study aimed to verify the safety of this type of catheter.MethodsStudy 1: Radiofrequency (RF) applications at a range of powers (30–50 W), contact forces (10–20 g), and durations (10–60 s) using perpendicular/parallel catheter orientation with half‐normal (HNS) or normal saline irrigation were compared between TactiFlex (4‐mm tip) and TactiCath (3.5‐mm tip) with temperature‐controlled mode in excised porcine hearts. Study 2: The relation between RF applications using TactiFlex and the incidence of steam‐pops in the real clinical cases were examined.ResultsStudy‐1: 576 RF lesions were examined. TactiFlex demonstrated a significantly lower risk of steam‐pops (5[1.7%] vs. 59[20.5%], p < .0001). Compared to 3.5‐mm‐tip catheter (TactiCath), 4‐mm‐tip catheter (TactiFlex) produced smaller lesion volume at perpendicular (193[98–554]mm3 vs. 263[139–436]mm3, p < .0001), but relatively similar lesion volume at parallel contact (243[105–443]mm3 vs. 278[180–440]mm3, p = .06). HNS‐irrigation tended to increase the lesion volume in both catheters and to increase the incidence of steam‐pops with TactiCath, but not with TactiFlex. The cut‐off value of %impedance‐drop ( = absolute impedance‐drop/initial impedance) of 20% predicted steam‐pops with a sensitivity = 100% and specificity = 89.6% in TactiFlex.Study‐2: 5496 RF applications in 84 patients (51AFs/8ATs/3AVNRTs/4AVRTs/17PVCs/4VTs) using TactiFlex were analyzed. Four steam‐pops (0.07%) in three patients with pericardial effusion were observed (%impedance‐drop = 24%/26%/29%/35%, respectively). The cut‐off value of %impedance‐drop = 20%, derived from ex‐vivo study, showed sensitivity = 100% and specificity = 90.1% in detecting steam‐pops.ConclusionTactiFlex reduced the risk of steam‐pops than TactiCath. %impedance‐drop ≤ 20% may be reasonable for safely use with a sufficient safety margin. For 4‐mm‐tip catheter, parallel‐contact may be recommended for larger lesion creation.

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Impact of irrigation flow rates on lesion size and safety of ablation catheters: an ex vivo porcine heart study

Ono,

Ishikawa,

Koyanagi

et al. 2024

Heart Vessels

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High-power short-duration catheter ablation of atrial fibrillation: is it really a new era? Comparison between new and old radiofrequency contact force–sensing catheters

Cited by 10 publications

References 31 publications

Posterior wall ablation for persistent atrial fibrillation: Very-high-power short-duration versus standard-power radiofrequency ablation

Posterior wall ablation for persistent atrial fibrillation: Very-high-power short-duration versus standard-power radiofrequency ablation

Safety verification of a novel irrigation catheter with flexible tip of laser‐cut kerfs and contact force sensor

Impact of irrigation flow rates on lesion size and safety of ablation catheters: an ex vivo porcine heart study

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