Impact of High-Power Short-Duration Radiofrequency Ablation on Long-Term Lesion Durability for Atrial Fibrillation Ablation

Hagai D. Yavin, Eran Leshem, Ayelet Shapira-Daniels, Jakub Sroubek, Michael Barkagan, Charles I. Haffajee, Joshua M. Cooper, Elad Anter*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)973-985
Number of pages13
JournalJACC: Clinical Electrophysiology
Volume6
Issue number8
DOIs
StatePublished - Aug 2020
Externally publishedYes

Funding

FundersFunder number
Abbott Medical
Affera Inc.
National Institutes of Health
Medtronic
Biosense Webster

    Keywords

    • ablation
    • atrial fibrillation
    • electrophysiology
    • radiofrequency

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