Low complication rates using high power (45–50 W) for short duration for atrial fibrillation ablations

Abstract

BACKGROUND Many centers use radiofrequency (RF) energy at 25-35 W for 30-60 seconds. There is a safety concern about using higher power, especially on the posterior wall.OBJECTIVE The purpose of this study was to examine complication rates for atrial fibrillation (AF) ablations performed with highpower, short-duration RF energy. METHODSWe examined the complication rates of 4 experienced centers performing AF ablations at RF powers from 45-50 W for 2-15 seconds per lesion. In total, 13,974 ablations were performed in 10,284 patients. On the posterior wall, 11,436 ablations used 45-50 W for 2-10 seconds, and 2538 ablations used power reduced to 35 W for 20 seconds. Esophageal temperature monitoring was used in 13,858 (99.2%).RESULTS Demographics were age 64 6 11 years, male 68%, left atrial size 4.4 6 0.7 cm, paroxysmal AF 37%, persistent AF 42%, longstanding AF 20%, antiarrhythmic drugs failed 1.4 6 0.7, hypertension 54%, diabetes 15%, previous cerebrovascular accident/ transient ischemic attack 7%, and CHA 2 DS 2 -VASc score 2.1 6 1.4. Procedural time was 116 6 41 minutes. Complications were death in 2 (0.014%; 1 due to stroke and 1 due to atrioesophageal fistula), pericardial tamponade in 33 (0.24%; 26 tapped, 7 surgical), strokes ,48 hours in 6 (0.043%), strokes 48 hours-30 days in 6 (0.043%), pulmonary vein stenosis requiring intervention in 2 (0.014%), phrenic nerve paralysis in 2 (0.014%; both resolved), steam pops 2 (0.014%) without complications, and catheter char 0 (0.00%). There was 1 atrioesophageal fistula in 11,436 ablations using power 45-50 W on the posterior wall and 3 in 2538 ablated with 35 W on the posterior wall (P 5 .021), although 2 of the 3 had no esophageal monitoring during a fluoroless procedure.CONCLUSION AF ablations can be performed at 45-50 W for short durations with very low complication rates. High-power, short-duration ablations have the potential to shorten procedural and total RF times and create more localized and durable lesions.

Comparison of high‐power short‐duration (HPSD) ablation of atrial fibrillation using a contact force‐sensing catheter and conventional technique: Initial results

“…Our protocol was effective and safe, despite a much smaller patient number, which is consistent with a recent study by Winkle et al, who reported the complication rates of four experienced centers performing AFib ablation with RF powers of 45‐50 W for 2‐15 seconds per lesion. In this analysis, 13 974 ablations were performed in a total of 10 284 patients.…”

Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter

“…However, HPSD strategies by themselves do not reduce ablation times. This was shown in a recently published multicenter study by Winkle et al where long procedure times and RF times were found despite the use of a heterogeneous HPSD strategy. Baher et al used 50 W for 5 seconds and found similar safety and efficacy with shorter procedure duration, compared with conventional PVI.…”

“…Several authors demonstrated the safety of such an approach till 50 W. There are however very few results on the outcomes. Winkle et al confirmed safety in a large heterogeneous multicentric trial. Procedure duration and RF time were significantly longer and showed more variation in this trial than in our single‐center study.…”

“…Single‐shot devices claim shorter procedure times with similar results . Several teams are working on high(er) power short duration (HPSD) protocols to shorten procedure times and improve cath lab utilization without a decrease in safety or efficacy …”

High‐power short‐duration ablation: Turn up the heat to cool down the esophagus

“…There was widespread concern among the electrophysiologists that it might be too dangerous and result in more complications, especially atrial esophageal fistulas. These concerns have been partially dispelled by a multicenter report on 13 974 ablations done in approximately 10 284 patients including the use of HPSD on the posterior wall . The complications rate was remarkably low, and this has encouraged many to start utilizing HPSD.…”