Temperature- and flow-controlled ablation/very-high-power short-duration ablation vs conventional power-controlled ablation: Comparison of focal and linear lesion characteristics

Takigawa, Masateru; Kitamura, Τakeshi; Martin, Claire; Fuimaono, Kristine; Datta, Keshava K.; Joshi, Helee; Constantin, Marion; Bourier, Félix; Cheniti, Ghassen; Duchâteau, Josselin; Pambrun, Thomas; Denis, Arnaud; Derval, Nicolas; Sacher, Frédéric; Cochet, Hubert; Hocini, Mélèze; Haı̈ssaguerre, Michel; Jaı̈s, Pierre

doi:10.1016/j.hrthm.2020.10.021

Cited by 41 publications

(77 citation statements)

References 9 publications

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“…Regarding safety, and closely related to this, a higher incidence of steam pops was found with HPSD with no temperature limitation during power control [4,5]. The risk of steam pops appears to be reduced by using HPSD under temperature control [6]. It was also seen that higher contact forces than 40 g between electrode and tissue caused a higher incidence of steam pops [5].…”

Section: Introductionmentioning

confidence: 84%

“…To apply constant RF power, the electrical current was adjusted by calculating the electrical impedance. We conducted a total of 12 simulations: 2 based on the standard settings (20 W-45 s and 30 W-30 s) and 2 based on HPSD (70 W-7 s and 90 W-4 s, as in [4][5][6][7]). Three catheter orientations were considered for each setting: perpendicular, 45 and parallel.…”

Section: Boundary Conditionsmentioning

confidence: 99%

“…The effectiveness of each setting was assessed by its capacity to create deep and wide lesions, which were characterized by the following parameters (see Figure 1(A)) [21,22]: maximum depth (D) and surface width (SW). The thermal lesions computed with standard and HPSD settings were compared with data from previous experimental studies [4][5][6][7]23,24] and lesion growth was measured 1 min after RF power switch-off.…”

Section: Assessment Of Effectiveness and Safetymentioning

confidence: 99%

“…It is reasonable to assume that the ideal setting will depend on the individual patient, along with the conditions around the target zone. Although the standard setting used with irrigated-tip electrodes to ablate atrial fibrillation consists of 20-30 W power and relatively long duration (45-60 s), recent studies [4][5][6][7] have explored the feasibility of new settings based on high-power (70-90 W) and short-duration (4-7 s) (HPSD), with the aim of creating transmural lesions with fewer complications than at the standard setting. The essential difference between both settings has to do with the thermodynamic response.…”

Section: Introductionmentioning

confidence: 99%

“…In terms of effectiveness, some in vivo studies conducted on a porcine model compare the performance of standard setting vs. HPSD for Pulmonary Vein Isolation (PVI) [4][5][6]. Overall, these studies reported that the HPSD lesions were significantly wider than and of similar depth to the standard settings, suggesting that HPSD is better for PVI due to increased lesion-to-lesion uniformity and linear continuity, given the larger lesion diameter.…”

Section: Introductionmentioning

confidence: 99%

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

Coderch-Navarro

Berjano

Cámara

et al. 2021

International Journal of Hyperthermia

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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.

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Section: Introductionmentioning

confidence: 84%

Section: Boundary Conditionsmentioning

confidence: 99%

Section: Assessment Of Effectiveness and Safetymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Coderch-Navarro

Berjano

Cámara

et al. 2021

International Journal of Hyperthermia

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Detailed investigation of the lesion formation with a novel contact force sensing catheter with a mesh‐shaped irrigation tip

Matsumoto

Kawano

Sasaki

et al. 2023

Journal of Arrhythmia

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Background: Recently, a novel contact force (CF) sensing catheter with mesh-shaped irrigation tip (TactiFlex SE, Abbott) was invented and is expected to be useful for safe and effective radiofrequency ablation. However, this catheter's detailed characteristics of the lesion formation are unknown. Methods:With an in vitro model, TactiFlex SE and its predecessor, FlexAbility SE, were used. A cross-sectional analysis of 60 s lesions (combination of various energy power settings [30, 40, and 50 W], and CFs [10, 30, and 50 g]) and longitudinal analysis (combination of various powers [40 or 50 W], CFs [10, 30, and 50 g] and ablation times [10, 20, 30, 40, 50, and 60 s]) of both catheters were analyzed and compared.Results: One hundred eighty RF lesions were created in protocol 1 and 300 in protocol 2. The lesion formation, impedance changes, and steam pops characteristics were similar between the two catheters. Higher CFs were related to higher incidences of steam pops. A nonlinear, time-dependent increase in the lesion depth and diameter was observed for all power and CF settings, and linear, positive correlations between the RF delivery time and lesion volume were observed for all power settings.Compared with 40 W, a 50 W ablation created greater lesions. Longer durations with higher CF settings had a higher steam pop incidence. Conclusions:The lesion formation and incidence of steam pops with TactiFlex SE and FlexAbility SE were similar. A 40 or 50 W ablation with careful CF control not to exceed 30 g in addition to monitoring impedance drops was required to safely create transmural lesions.

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The effect of ablation settings on lesion characteristics with DiamondTemp ablation system: An ex vivo experiment

Nomura,

Maeda,

Kumazawa

et al. 2023

Journal of Arrhythmia

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IntroductionCreating large lesion in ablations using the DiamondTemp (DTA) ablation system may reduce the frequency of arrhythmia recurrence and allow the treatment of ventricular arrhythmias. Therefore, this study aimed to investigate whether power, application time, contact force (CF), and contact angle affect lesion formation in the ventricles.MethodsAblations were delivered to porcine myocardial preps to evaluate the lesion characteristics. Ablations were conducted with a maximum power of 50 W, target temperature of 58°C, CF of 10, 20, or 30 g, and contact angle between the catheter tip and tissue. The ablation durations were 15, 30, 60 s, 15 s × 2, or 30 s × 2.ResultsSteam pops occurred only in cases with perpendicular contact. The lesion depth was larger in all settings in the perpendicular orientation than in the parallel orientation. The temperatures were lower in all settings in the perpendicular orientation than in the parallel orientation. The lesions became larger as CF increased with perpendicular contact and duration of ≥30 s. The longer application time resulted in larger surface area, depth, and volume of the lesion. Lesion depth was greater with single application of 30 and 60 s than with 15 s × 2 and 30 s × 2, respectively.ConclusionIt is important to perform a single prolonged application as much as possible to create deeper lesions. Parallel contact with the tissue should be maintained to take advantage of the temperature sensor's capabilities to avoid pop phenomenon.

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Temperature- and flow-controlled ablation/very-high-power short-duration ablation vs conventional power-controlled ablation: Comparison of focal and linear lesion characteristics

Cited by 41 publications

References 9 publications

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

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

Detailed investigation of the lesion formation with a novel contact force sensing catheter with a mesh‐shaped irrigation tip

The effect of ablation settings on lesion characteristics with DiamondTemp ablation system: An ex vivo experiment

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