open access

Ahead of print
Research paper
Published online: 2020-03-11
Get Citation

The low acute effectiveness of a high-power short duration radiofrequency current application technique in pulmonary vein isolation for atrial fibrillation

Ekrem Ücer, Carsten Jungbauer, Christian Hauck, Manuel Kaufmann, Florian Poschenrieder, Lars Maier, Sabine Fredersdorf
DOI: 10.5603/CJ.a2020.0033
·
Pubmed: 32207843

open access

Ahead of print
Original articles
Published online: 2020-03-11

Abstract

Background: Application of high power radiofrequency (RF) energy for a short duration (HPSD) to isolate pulmonary vein (PV) is an emerging technique. But power and duration settings are very different across different centers. Moreover, despite encouraging preclinical and clinical data, studies measuring acute effectiveness of various HPSD settings are limited.

Methods: Twenty-five consecutive patients with symptomatic atrial fibrillation (AF) were treated with pulmonary vein isolation (PVI) using HPSD. PVI was performed with a contact force catheter (Thermocool SF Smart-Touch) and Carto 3 System. The  following parameters were used: energy output 50 W, target temperature 43°C, irrigation 15 mL/min, targeted contact force of > 10 g. RF energy was applied for 6 to 10 s. Required minimal interlesion distance was 4 mm. Twenty minutes after each successful PVI adenosine provocation test (APT) was performed by administrating 18 mg adenosine to unmask dormant PV conduction.

Results: All PVs (100 PVs) were successfully isolated. RF lesions needed per patient were 131 ±  41, the average duration for each RF application was 8.1 ± 1.7 s. Procedure time was 138  ±  21 min and average of total RF energy duration was 16.3 ±  5.2 min and average amount of RF energy was 48209 ± 12808W s. APT application time after PVI was 31.1 ± 8.3 min for the left sided PVs and 22.2 ± 4.6 min (p = 0.005) for the right sided PVs. APT was transiently positive in 18 PVs (18%) in 8 (32%) patients.

Conclusions: Pulmonary vein isolation with high power for 6–10 s is feasible and shortens the procedure and ablation duration. However, acute effectiveness of the HPSD seems to be lower than expected. Further studies combining other ablation parameters are needed to improve this promising technique.

Abstract

Background: Application of high power radiofrequency (RF) energy for a short duration (HPSD) to isolate pulmonary vein (PV) is an emerging technique. But power and duration settings are very different across different centers. Moreover, despite encouraging preclinical and clinical data, studies measuring acute effectiveness of various HPSD settings are limited.

Methods: Twenty-five consecutive patients with symptomatic atrial fibrillation (AF) were treated with pulmonary vein isolation (PVI) using HPSD. PVI was performed with a contact force catheter (Thermocool SF Smart-Touch) and Carto 3 System. The  following parameters were used: energy output 50 W, target temperature 43°C, irrigation 15 mL/min, targeted contact force of > 10 g. RF energy was applied for 6 to 10 s. Required minimal interlesion distance was 4 mm. Twenty minutes after each successful PVI adenosine provocation test (APT) was performed by administrating 18 mg adenosine to unmask dormant PV conduction.

Results: All PVs (100 PVs) were successfully isolated. RF lesions needed per patient were 131 ±  41, the average duration for each RF application was 8.1 ± 1.7 s. Procedure time was 138  ±  21 min and average of total RF energy duration was 16.3 ±  5.2 min and average amount of RF energy was 48209 ± 12808W s. APT application time after PVI was 31.1 ± 8.3 min for the left sided PVs and 22.2 ± 4.6 min (p = 0.005) for the right sided PVs. APT was transiently positive in 18 PVs (18%) in 8 (32%) patients.

Conclusions: Pulmonary vein isolation with high power for 6–10 s is feasible and shortens the procedure and ablation duration. However, acute effectiveness of the HPSD seems to be lower than expected. Further studies combining other ablation parameters are needed to improve this promising technique.

Get Citation

Keywords

ablation, atrial fibrillation, reconnection, adenosine, high power

About this article
Title

The low acute effectiveness of a high-power short duration radiofrequency current application technique in pulmonary vein isolation for atrial fibrillation

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Research paper

Published online

2020-03-11

DOI

10.5603/CJ.a2020.0033

Pubmed

32207843

Keywords

ablation
atrial fibrillation
reconnection
adenosine
high power

Authors

Ekrem Ücer
Carsten Jungbauer
Christian Hauck
Manuel Kaufmann
Florian Poschenrieder
Lars Maier
Sabine Fredersdorf

References (21)
  1. Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998; 339(10): 659–666.
  2. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace. 2017 ; 14(10): e275–e444.
  3. Medi C, Sparks PB, Morton JB, et al. Pulmonary vein antral isolation for paroxysmal atrial fibrillation: results from long-term follow-up. J Cardiovasc Electrophysiol. 2011; 22(2): 137–141.
  4. Bhaskaran A, Chik W, Pouliopoulos J, et al. Five seconds of 50-60 W radio frequency atrial ablations were transmural and safe: an in vitro mechanistic assessment and force-controlled in vivo validation. Europace. 2017; 19(5): 874–880.
  5. Borne RT, Sauer WH, Zipse MM, et al. Longer duration versus increasing power during radiofrequency ablation yields different ablation lesion characteristics. JACC Clin Electrophysiol. 2018; 4(7): 902–908.
  6. Kanj MH, Wazni O, Fahmy T, et al. Pulmonary vein antral isolation using an open irrigation ablation catheter for the treatment of atrial fibrillation: a randomized pilot study. J Am Coll Cardiol. 2007; 49(15): 1634–1641.
  7. Bunch TJ, Day JD. Novel ablative approach for atrial fibrillation to decrease risk of esophageal injury. Heart Rhythm. 2008; 5(4): 624–627.
  8. Winkle RA, Moskovitz R, Hardwin Mead R, et al. Atrial fibrillation ablation using very short duration 50 W ablations and contact force sensing catheters. J Interv Card Electrophysiol. 2018; 52(1): 1–8.
  9. Winkle RA, Mohanty S, Patrawala RA, et al. Low complication rates using high power (45-50 W) for short duration for atrial fibrillation ablations. Heart Rhythm. 2019; 16(2): 165–169.
  10. Macle L, Khairy P, Weerasooriya R, et al. Adenosine-guided pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation: an international, multicentre, randomised superiority trial. Lancet. 2015; 386(9994): 672–679.
  11. Kobori A, Shizuta S, Inoue K, et al. Adenosine triphosphate-guided pulmonary vein isolation for atrial fibrillation: the UNmasking Dormant Electrical Reconduction by Adenosine TriPhosphate (UNDER-ATP) trial. Eur Heart J. 2015; 36(46): 3276–3287.
  12. Ücer E, Janeczko Y, Seegers J, et al. A RAndomized Trial to compare the acute reconnection after pulmonary vein ISolation with Laser-BalloON versus radiofrequency Ablation: RATISBONA trial. J Cardiovasc Electrophysiol. 2018; 29(5): 733–739.
  13. Leshem E, Zilberman I, Tschabrunn CM, et al. High-Power and short-duration ablation for pulmonary vein isolation: biophysical characterization. JACC Clin Electrophysiol. 2018; 4(4): 467–479.
  14. Arentz T, Macle L, Kalusche D, et al. "Dormant" pulmonary vein conduction revealed by adenosine after ostial radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 2004; 15(9): 1041–1047.
  15. McLellan AJA, Kumar S, Smith C, et al. The role of adenosine following pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a systematic review. J Cardiovasc Electrophysiol. 2013; 24(7): 742–751.
  16. Andrade JG, Monir G, Pollak SJ, et al. Pulmonary vein isolation using "contact force" ablation: the effect on dormant conduction and long-term freedom from recurrent atrial fibrillation--a prospective study. Heart Rhythm. 2014; 11(11): 1919–1924.
  17. Neuzil P, Reddy VY, Kautzner J, et al. Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circ Arrhythm Electrophysiol. 2013; 6(2): 327–333.
  18. Phlips T, Taghji P, El Haddad M, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the 'CLOSE'-protocol. Europace. 2018; 20(FI_3): f419–f427.
  19. Chen S, Schmidt B, Bordignon S, et al. Ablation index-guided 50 W ablation for pulmonary vein isolation in patients with atrial fibrillation: Procedural data, lesion analysis, and initial results from the FAFA AI High Power Study. J Cardiovasc Electrophysiol. 2019; 30(12): 2724–2731.
  20. Okamatsu H, Koyama J, Sakai Y, et al. High-power application is associated with shorter procedure time and higher rate of first-pass pulmonary vein isolation in ablation index-guided atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2019; 30(12): 2751–2758.
  21. Di Biase L, Conti S, Mohanty P, et al. General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study. Heart Rhythm. 2011; 8(3): 368–372.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl