Author + information
- Received February 7, 2020
- Revision received April 23, 2020
- Accepted April 24, 2020
- Published online August 17, 2020.
- Hagai D. Yavin, MDa,
- Eran Leshem, MD, MHAb,
- Ayelet Shapira-Daniels, MDb,
- Jakub Sroubek, MD, PhDc,
- Michael Barkagan, MDb,
- Charles I. Haffajee, MDb,
- Joshua M. Cooper, MDd and
- Elad Anter, MDa,∗ ()
- aCardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- bDavidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center Ramat Gan, Tel Hashomer, and Sackler School of Medicine, Tel Aviv, Israel
- cHarvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- dSection of Cardiac Electrophysiology, Temple University Hospital, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Elad Anter, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, J1-133, Cleveland, Ohio 44195.
Objectives The goal of this study was to compare lesion durability between high-power short-duration (HP-SD) and moderate-power moderate-duration (MP-MD) ablation strategies.
Background HP-SD radiofrequency ablation (RFA) was developed to improve pulmonary vein isolation (PVI) by reducing the effect of catheter instability inherent to MP-MD ablation strategies. However, its long-term effect on lesion durability for the treatment of atrial fibrillation is unknown.
Methods Patients with atrial fibrillation (n = 112) underwent PVI using HP-SD ablation (45 to 50 W, 8 to 15 s) with contact force-sensing open irrigated catheter. Cavotricuspid isthmus, mitral annular, and roof lines were permitted. A control group (n = 112) underwent ablation using MP-MD ablation (20 to 40 W, 20 to 30 s) with similar technology. Chronic PV reconnection was examined in patients who required a redo procedure (HP-SD ablation, n = 18; MP-MD ablation, n = 23).
Results The rate of PVI at the completion of the initial encirclement was similar between the HP-SD and MP-MD ablation strategies (90.2% vs. 83.0%; p = 0.006). The HP-SD strategy required shorter RFA time (17.2 ± 3.4 min vs. 31.1 ± 5.6 min; p < 0.001). The incidence of chronic PV reconnection was lower with HP-SD ablation (16.6% vs. 52.2%; p = 0.03). Areas of chronic reconnection were associated with catheter motion ≥1 mm for ≥50% application duration. In a higher proportion of HP-SD applications, catheter motion was <1 mm during ≥50% duration (88.6% vs. 72.8%; p < 0.001), allowing energy delivery with greater stability. Both ablation strategies were effective for cavotricuspid isthmus; however, the HP-SD strategy was less effective for mitral annular lines, requiring ablation at lower power for longer duration to avoid steam pops.
Conclusions HP-SD ablation may improve PVI durability, and it shortens RFA time. However, ablation in thicker myocardium often requires lower power applied for longer duration, allowing deeper lesions without tissue overheating.
Dr. Shapira-Daniels has received a T32 grant from the National Institutes of Health. Dr. Cooper has been a consultant on educational material for Johnson & Johnson; has been a consultant on fellow educational programs for Boston Scientific; has been a consultant on fellow education for Medtronic; and has been a clinical trial committee member for Abbott Medical. Dr. Anter has received research grants from Abbott Medical, Affera Inc., Biosense Webster, Boston Scientific, Itamar Medical, and Philips Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received February 7, 2020.
- Revision received April 23, 2020.
- Accepted April 24, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.