High-power short-duration vs. standard radiofrequency cardiac ablation: comparative study based on an in-silico model

Abstract

Purpose: While the standard setting during radiofrequency catheter ablation (RFCA) consists of applying low power for long times, a new setting based on high power and short duration (HPSD) has recently been suggested as safer and more effective. Our aim was to compare the electrical and thermal performance of standard vs. HPSD settings, especially to assess the effect of the catheter orientation. Methods: A 3D computational model was built based on a coupled electric-thermal-flow problem. Standard (20 W-45 s and 30 W-30 s) and HPSD settings (70 W-7 s and 90 W-4 s) were compared. Since the model only included a cardiac tissue fragment, the power values were adjusted to 80% of the clinical values (15, 23, 53 and 69 W). Three catheter-tissue orientations were considered (90 , 45 and 0 ). Thermal lesions were assessed by the Arrhenius equation. Safety was assessed by checking the occurrence of steam pops (100 C in tissue) and thrombus formation (80 C in blood). Results: The computed thermal lesions were in close agreement with the experimental data in the literature, in particular with in vivo studies. HPSD created shallower and wider lesions than standard settings, especially with the catheter at 45 . Steam pops occurred earlier with HPSD, regardless of catheter orientation. Conclusion: HPSD seems to be more effective in cases that need shallow and extensive lesions, especially when the catheter is at 0 or at 45 , as used in 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

“…It is well-known that HPSD ablation results in a different lesion geometry (e.g., larger diameters but smaller depth) compared to conventional lower power ablation. Still, the depth of the HP applications is sufficient to create transmural lesions in the atria ( 31 , 32 ). Our results comparing LPLD (30 W) and HPSD (50 W) ablation complement the findings of Hoffmann et al, who investigated the desirable target ILD during PVI (the power setting was 30 W throughout the study).…”

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

“…[33][34][35][36] Overall, high-power short-duration lesions were significantly wider, and of slightly lower or similar depth compared to standard settings. 33 The increased lesion-to-lesion uniformity and linear continuity, given the larger lesion diameter, is most beneficial in establishing permanent PVI. 36 Otherwise, the slightly diminished lesion depth is of less concern while ablating the relatively thinwalled atria (compared to the ventricle).…”

“…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 . The increased lesion‐to‐lesion uniformity and linear continuity, given the larger lesion diameter, is most beneficial in establishing permanent PVI 36 .…”

“…The increased lesion‐to‐lesion uniformity and linear continuity, given the larger lesion diameter, is most beneficial in establishing permanent PVI 36 . Otherwise, the slightly diminished lesion depth is of less concern while ablating the relatively thin‐walled atria (compared to the ventricle) 33 . Whether high power short duration lesions result in improved outcomes, is still a matter of ongoing debate.…”

Computer modeling of radiofrequency cardiac ablation: 30 years of bioengineering research

“…For example, needle-like electrodes have been developed to achieve deep lesions in the ventricular wall [15] , as well as new shapes and materials to join electrodes and catheters to reduce the hot points in this zone [14] and different metal materials to achieve better heat evacuation through the electrode body and increase lesion size [46] . Computer modeling has also been used to explore the performance of different modes of applying RF energy, such as constant temperature [ 9 , 21 , 47 ], constant power [21] , and high power in short durations [48][49][50] .…”