Superior vena cava isolation with 50 W high power, short duration ablation strategy

Abstract

Introduction The optimal ablation strategy is unknown regarding a superior vena cava isolation (SVCI). This study aimed to examine the feasibility and safety and to analyze the lesion characteristics of the SVCI using high‐power, short‐duration (HPSD) ablation. Methods and Results A total of 100 patients underwent an index SVCI using HPSD (n = 50, HPSD group) or conventional lower‐power and longer‐duration (n = 50, LPLD group) ablation, using the Thermocool Smarttouch SF. In the HPSD group, ablation was performed with a power of 50 W for 7 s, and was limited to 4 s at the lateral segment close to the right phrenic nerve. The ablation setting used in the LPLD group was 20–25 W for 20–30 s and was limited to 10–20 W for 15–30 s at the lateral segment when diaphragmatic capture was seen. An electrical SVCI was achieved in all patients. The HPSD group required a significantly shorter procedure time (10.8 ± 3.2 vs. 14.8 ± 6.4 min; p < .01), shorter radiofrequency duration (49 ± 16 vs. 282 ± 124 s; p < .01), fewer lesions (8.3 ± 2.5 vs. 10.4 ± 4.4; p < .01), and lower ablation index (316 ± 38 vs. 356 ± 62; p < .001) than the LPLD group. The incidence of a postprocedural asymptomatic mild diaphragmatic elevation was comparable (2% in the HPSD group vs. 6% in the LPLD group; p = .61). Conclusion The 50‐W HPSD ablation strategy allowed for a successful, fast, and safe SVCI with the fewer ablation lesions and the lower ablation index.

Safety and efficacy of percutaneous coronary intervention combined with catheter ablation in a single procedure for patients with coronary artery disease complicated with atrial fibrillation

“…The SMART-AF study, a singleprocedure ablation study using the traditional six-hole tip catheter, reported an average procedural duration of 222.7 + 86.4 min [35]. The new 56-hole porous tip catheter in the present study allows delivery of higher power RF within a short ablation duration [31]; meanwhile, the operator's rich experience also smoothed the procedure.…”

“…This new catheter bears a 56-hole porous tip. Compared with the traditional six-hole irrigation system, the porous tip enhances the cooling effect with less uid, allowing more e cient heat dissipation and higher power radiofrequency delivery [31,32]. Previous studies show that this new porous-tip catheter brings fewer AEs during PAF and/or PsAF ablation, suggesting its favorable safety [26,27,32].…”

In vivo tissue temperature during lesion size index‐guided 50W ablation versus 30W ablation: A porcine study

“…1 Results of a clinical study in which the STSF was used suggested clinical acceptability of the use of 50 W power and ≤4-s energy delivery to the SVC close to the phrenic nerve, although this strategy should be carefully applied. 25 Even if HPSD ablation with energy delivery lasting <6 s is used, greater distance between lesions (perhaps around 6 mm, judging from our lesion width) and a longer waiting time (>49.8 s for t-T base ) after a previous energy delivery may be an option to minimize esophageal injury during posterior LA wall ablation. In fact, it has been recommended that in the context of 50 W/6-s HPSD ablation, RF energy not be applied within 20 mm of a previous lesion for at least 60 s at the posterior wall of the LA because of observation of an additive luminal esophageal temperature increase when consecutive lesions were placed <20 mm apart within 60 s. 26…”

“…Indeed, a recent study indicated that a setting of 50 W for 2–3 s might be an option for the posterior LA wall ablation 1 . Results of a clinical study in which the STSF was used suggested clinical acceptability of the use of 50 W power and ≤4‐s energy delivery to the SVC close to the phrenic nerve, although this strategy should be carefully applied 25 . Even if HPSD ablation with energy delivery lasting <6 s is used, greater distance between lesions (perhaps around 6 mm, judging from our lesion width) and a longer waiting time (>49.8 s for t‐ T base ) after a previous energy delivery may be an option to minimize esophageal injury during posterior LA wall ablation.…”

Percutaneous Treatment Approaches in Atrial Fibrillation: Current Landscape and Future Perspectives

“…This could be associated with progressive fibrous atrial cardiomyopathy, which may be evident in the long term after HPSD [ 55 ]. Posterior box and superior vena cava isolation are also feasible with a HPSD ablation method [ 56 , 57 ]. Additionally, HPSD is an appropriate option in redo CA procedures, as shown by Junarta et al [ 58 ].…”