Juan J Pérez1, Robert D'Angelo2, Ana González-Suárez3,4, Hiroshi Nakagawa5, Enrique Berjano1, Andre d'Avila6. 1. BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain. 2. Division of Cardiovascular Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA. 3. Electrical and Electronic Engineering, National University of Ireland Galway, Galway, Ireland. 4. Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland. 5. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA. 6. Division of Cardiovascular Medicine, Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA. adavila@bidmc.harvard.edu.
Abstract
BACKGROUND: Pilot clinical studies suggest that very high power-very short duration (vHPvSD, 90 W/4 s, 360 J energy) is a feasible and safe technique for ablation of atrial fibrillation (AF), compared with standard applications using moderate power-moderate duration (30 W/30 s, 900 J energy). However, it is unclear whether alternate power and duration settings for the delivery of the same total energy would result in similar lesion formation. This study compares temperature dynamics and lesion size at different power-duration settings for the delivery of equivalent total energy (360 J). METHODS: An in silico model of radiofrequency (RF) ablation was created using the Arrhenius function to estimate lesion size under different power-duration settings with energy balanced at 360 J: 30 W/12 s (MPSD), 50 W/7.2 s (HPSD), and 90 W/4 s (vHPvSD). Three catheter orientations were considered: parallel, 45°, and perpendicular. RESULTS: In homogenous tissue, vHPvSD and HPSD produced similar size lesions independent of catheter orientation, both of which were slightly larger than MPSD (lesion size 0.1 mm deeper, ~ 0.7 mm wider, and ~ 25 mm3 larger volume). When considering heterogeneous tissue, these differences were smaller. Tissue reached higher absolute temperature with vHPvSD and HPSD (5-8 °C higher), which might increase risk of collateral tissue injury or steam pops. CONCLUSION: Ablation for AF using MPSD or HPSD may be a feasible alternative to vHPvSD ablation given similar size lesions with similar total energy delivery (360 J). Lower absolute tissue temperature and slower heating may reduce risk of collateral tissue injury and steam pops associated with vHPvSD and longer applications using moderate power.
BACKGROUND: Pilot clinical studies suggest that very high power-very short duration (vHPvSD, 90 W/4 s, 360 J energy) is a feasible and safe technique for ablation of atrial fibrillation (AF), compared with standard applications using moderate power-moderate duration (30 W/30 s, 900 J energy). However, it is unclear whether alternate power and duration settings for the delivery of the same total energy would result in similar lesion formation. This study compares temperature dynamics and lesion size at different power-duration settings for the delivery of equivalent total energy (360 J). METHODS: An in silico model of radiofrequency (RF) ablation was created using the Arrhenius function to estimate lesion size under different power-duration settings with energy balanced at 360 J: 30 W/12 s (MPSD), 50 W/7.2 s (HPSD), and 90 W/4 s (vHPvSD). Three catheter orientations were considered: parallel, 45°, and perpendicular. RESULTS: In homogenous tissue, vHPvSD and HPSD produced similar size lesions independent of catheter orientation, both of which were slightly larger than MPSD (lesion size 0.1 mm deeper, ~ 0.7 mm wider, and ~ 25 mm3 larger volume). When considering heterogeneous tissue, these differences were smaller. Tissue reached higher absolute temperature with vHPvSD and HPSD (5-8 °C higher), which might increase risk of collateral tissue injury or steam pops. CONCLUSION: Ablation for AF using MPSD or HPSD may be a feasible alternative to vHPvSD ablation given similar size lesions with similar total energy delivery (360 J). Lower absolute tissue temperature and slower heating may reduce risk of collateral tissue injury and steam pops associated with vHPvSD and longer applications using moderate power.
Authors: Vivek Y Reddy; Massimo Grimaldi; Tom De Potter; Johan M Vijgen; Alan Bulava; Mattias Francis Duytschaever; Martin Martinek; Andrea Natale; Sebastien Knecht; Petr Neuzil; Helmut Pürerfellner Journal: JACC Clin Electrophysiol Date: 2019-05-08