High-power and short-duration ablation for pulmonary vein isolation: Safety, efficacy, and long-term durability

Michael Barkagan, Fernando M. Contreras-Valdes, Eran Leshem, Alfred E. Buxton, Hiroshi Nakagawa, Elad Anter*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)1287-1296
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Issue number9
StatePublished - Sep 2018
Externally publishedYes


FundersFunder number
Biosense Webster, Inc.
Biosense Webster


    • catheter ablation
    • pulmonary vein isolation
    • radiofrequency energy
    • right atrium


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