Michael Barkagan1, Fernando M Contreras-Valdes1, Eran Leshem1, Alfred E Buxton1, Hiroshi Nakagawa2, Elad Anter1. 1. Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 2. Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Abstract
INTRODUCTION: PV reconnection is often the result of catheter instability and tissue edema. High-power short-duration (HP-SD) ablation strategies have been shown to improve atrial linear continuity in acute pre-clinical models. This study compares the safety, efficacy, and long-term durability of HP-SD ablation with conventional ablation. METHODS AND RESULTS: In 6 swine, 2 ablation lines were performed anterior and posterior to the crista terminalis, in the smooth and trabeculated right atrium, respectively; and the right superior PV was isolated. In 3 swine, ablation was performed using conventional parameters (Thermocool-Smarttouch® SF; 30 W/30 seconds) and in 3 other swine using HP-SD parameters (QDOT-MICRO™, 90 W/4 seconds). After 30 days, linear integrity was examined by voltage mapping and pacing, and the heart and surrounding tissues were examined by histopathology. Acute line integrity was achieved with both ablation strategies; however, HP-SD ablation required 80% less RF time compared with conventional ablation (P ≤ 0.01 for all lines). Chronic line integrity was higher with HP-SD ablation: all 3 posterior lines were continuous and transmural compared to only 1 line created by conventional ablation. In the trabeculated tissue, HP-SD ablation lesions were wider and of similar depth with 1 of 3 lines being continuous compared to 0 of 3 using conventional ablation. Chronic PVI without stenosis was evident in both groups. There were no steam-pops. Pleural markings were present in both strategies, but parenchymal lung injury was only evident with conventional ablation. CONCLUSIONS: HP-SD ablation strategy results in improved linear continuity, shorter ablation time, and a safety profile comparable to conventional ablation.
INTRODUCTION: PV reconnection is often the result of catheter instability and tissue edema. High-power short-duration (HP-SD) ablation strategies have been shown to improve atrial linear continuity in acute pre-clinical models. This study compares the safety, efficacy, and long-term durability of HP-SD ablation with conventional ablation. METHODS AND RESULTS: In 6 swine, 2 ablation lines were performed anterior and posterior to the crista terminalis, in the smooth and trabeculated right atrium, respectively; and the right superior PV was isolated. In 3 swine, ablation was performed using conventional parameters (Thermocool-Smarttouch® SF; 30 W/30 seconds) and in 3 other swine using HP-SD parameters (QDOT-MICRO™, 90 W/4 seconds). After 30 days, linear integrity was examined by voltage mapping and pacing, and the heart and surrounding tissues were examined by histopathology. Acute line integrity was achieved with both ablation strategies; however, HP-SD ablation required 80% less RF time compared with conventional ablation (P ≤ 0.01 for all lines). Chronic line integrity was higher with HP-SD ablation: all 3 posterior lines were continuous and transmural compared to only 1 line created by conventional ablation. In the trabeculated tissue, HP-SD ablation lesions were wider and of similar depth with 1 of 3 lines being continuous compared to 0 of 3 using conventional ablation. Chronic PVI without stenosis was evident in both groups. There were no steam-pops. Pleural markings were present in both strategies, but parenchymal lung injury was only evident with conventional ablation. CONCLUSIONS:HP-SD ablation strategy results in improved linear continuity, shorter ablation time, and a safety profile comparable to conventional ablation.
Authors: Sergio Castrejón-Castrejón; Marcel Martínez Cossiani; Marta Ortega Molina; Carlos Escobar; Consuelo Froilán Torres; Nerea Gonzalo Bada; Marta Díaz de la Torre; José Manuel Suárez Parga; José Luis López Sendón; José Luis Merino Journal: J Interv Card Electrophysiol Date: 2019-11-12 Impact factor: 1.900
Authors: Mark J Mulder; Michiel J B Kemme; Marco J W Götte; Peter M van de Ven; Herbert A Hauer; Giovanni J M Tahapary; Albert C van Rossum; Cornelis P Allaart Journal: J Cardiovasc Electrophysiol Date: 2020-05-22