High-Power and Short-Duration Ablation for Pulmonary Vein Isolation Biophysical Characterization

被引:269
作者
Leshem, Eran [1 ]
Zilberman, Israel [2 ]
Tschabrunn, Cory M. [1 ]
Barkagan, Michael [1 ]
Contreras-Valdes, Fernando M. [1 ]
Govari, Assaf [2 ]
Anter, Elad [1 ]
机构
[1] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Med, Harvard Thorndike Electrophysiol Inst,Cardiovasc, Boston, MA 02115 USA
[2] Biosense Webster, Res & Dev, Haifa, Israel
基金
美国国家卫生研究院;
关键词
catheter ablation; electrophysiology; high power; radiofrequency; ablation biophysics;
D O I
10.1016/j.jacep.2017.11.018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES This study sought to examine the biophysical properties of high-power and short-duration (HP-SD) radiofrequency ablation for pulmonary vein isolation. BACKGROUND Pulmonary vein isolation is the cornerstone of atrial fibrillation ablation. However, pulmonary vein reconnection is frequent and is often the result of catheter instability, tissue edema, and a reversible nontransmural injury. We postulated that HP-SD ablation increases lesion-to-lesion uniformity and transmurality. METHODS This study included 20 swine and a novel open-irrigated ablation catheter with a thermocouple system able to record temperature at the catheter-tissue interface (QDOT Micro Catheter). Step 1 compared 3 HP-SD ablation settings: 90 W/4 s, 90 W/6 s, and 70 W/8 s in a thigh muscle preparation. Ablation at 90 W/4 s was identified as the best compromise between lesion size and safety parameters, with no steam-pop or char. In step 2, a total of 174 single ablation applications were performed in the beating heart and resulted in 3 (1.7%) steam-pops, all occurring at cathetertissue interface temperature >= 85 degrees C. Additional 233 applications at 90 W/4 s and temperature limit of 65 degrees C were applied without steam-pop. Step 3 compared the presence of gaps and lesion transmurality in atrial lines and pulmonary vein isolation between HP-SD (90 W/4 s, T <= 65 degrees C) and standard (25 W/20 s) ablation. RESULTS HP-SD ablation resulted in 100% contiguous lines with all transmural lesions, whereas standard ablation had linear gaps in 25% and partial thickness lesions in 29%. Ablation with HP-SD produced wider lesions (6.02 +/- 0.2 mm vs. 4.43 +/- 1.0 mm; p = 0.003) at similar depth (3.58 +/- 0.3 mm vs. 3.53 +/- 0.6 mm; p = 0.81) and improved lesion-to-lesion uniformity with comparable safety end points. CONCLUSIONS In a preclinical model, HP-SD ablation (90 W/4 s, T <= 65 degrees C) produced an improved lesion-tolesion uniformity, linear contiguity, and transmurality at a similar safety profile of conventional ablation. (C) 2018 by the American College of Cardiology Foundation.
引用
收藏
页码:467 / 479
页数:13
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