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High-power, Short-duration Radiofrequency Ablation for the Treatment of AF.

ABSTRACT: High-power, short-duration (HPSD) ablation for the treatment of AF is emerging as an alternative to ablation using conventional ablation generator settings characterised by lower power and longer duration. Although the reported potential advantages of HPSD ablation include less tissue oedema and collateral tissue damage, a reduction in procedural time and superior ablation lesion formation, clinical studies of HPSD ablation validating these observations are limited. One of the main challenges for HPSD ablation has been the inability to adequately assess temperature and lesion formation in real time. Novel catheter designs may improve the accuracy of intra-ablation temperature recording and correspondingly may improve the safety profile of HPSD ablation. Clinical studies of HPSD ablation are on-going and interpretation of the data from these and other studies will be required to ascertain the clinical value of HPSD ablation.

SUBMITTER: Kotadia ID

PROVIDER: S-EPMC7358956 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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High-power, Short-duration Radiofrequency Ablation for the Treatment of AF.

Kotadia Irum D ID Williams Steven E SE O'Neill Mark M

Arrhythmia & electrophysiology review 20200201 4

High-power, short-duration (HPSD) ablation for the treatment of AF is emerging as an alternative to ablation using conventional ablation generator settings characterised by lower power and longer duration. Although the reported potential advantages of HPSD ablation include less tissue oedema and collateral tissue damage, a reduction in procedural time and superior ablation lesion formation, clinical studies of HPSD ablation validating these observations are limited. One of the main challenges fo ...[more]

PMID: 32685157

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Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation.

Project description:ObjectiveHigh power short duration (HPSD) ablation strategy is proposed to be more effective than low power long duration (LPLD) for radiofrequency ablation of atrial fibrillation. Although small trials abound, data from a large cohort are lacking. This meta-analysis compares all the existing studies comparing these two approaches to evaluate perceived advantages of one over the other.MethodsA systematic search of PubMed, EMBASE, and Cochrane databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model.ResultsAblation settings varied widely across 20 studies comprising 2,136 patients who underwent HPSD and 1,753 patients who underwent LPLD. The pooled incidence of atrial arrhythmia recurrence after HPSD ablation was 20% [95% confidence interval (CI): 0.16-0.25; I2=88%]. Atrial arrhythmia recurrences were significantly less frequent with HPSD ablation (incidence risk ratio=0.66; 95% CI: 0.49-0.88; I2=72%; p=0.004). Procedural, fluoroscopy, and ablation times were significantly shorter with HPSD ablation. First-pass pulmonary vein isolations (PVIs) were significantly more [odds ratio (OR)=2.94; 95% CI: 1.50-5.77; I2=89%; p=0.002), and acute pulmonary vein reconnections (PVRs) were significantly lesser (OR=0.41; 95% CI: 0.28-0.62; I2=62%; p<0.001) in the HPSD group. Although radiofrequency energy was significantly higher, esophageal thermal injuries (ETI) were lower with HPSD ablation. Acute complications, including steam-pops, were rare and statistically similar in both the groups.ConclusionHPSD ablation enables faster first-pass PVI with fewer PVRs, similar ETI rates, rare collateral damage, and lower recurrence of atrial arrhythmia in the long term than LPLD. Randomized controlled studies with a larger cohort are indicated both to confirm the benefit of HPSD ablation and standardize the ablation protocol.

| S-EPMC8878944 | biostudies-literature

Efficacy and Safety of High-Power Short-Duration Radiofrequency Catheter Ablation of Atrial Fibrillation.

Project description:Introduction: Whereas, high-power short-duration (HPSD) radiofrequency (RF) ablation is generally used in atrial fibrillation (AF) catheter ablation (CA), its efficacy, safety, and influence on autonomic function have not been well established in a large population. This study compared HPSD-AFCA and conventional power (ConvP)-AFCA in propensity score matched-population. Methods: In 3,045 consecutive patients who underwent AFCA, this study included 1,260 patients (73.9% male, 59 ± 10 years old, 58.2% paroxysmal type) after propensity score matching: 315 in 50~60W HPSD group vs. 945 in the ConvP group. This study investigated the procedural factors, complication rate, rhythm status, and 3-month heart rate variability (HRV) between the two groups and subgroups. Results: Procedure time was considerably short in the HPSD group (135 min in HPSD vs. 181 min in ConvP, p < 0.001) compared to ConvP group, but there was no significant difference in the complication rate (2.9% in HPSD vs. 3.7% in ConvP, p = 0.477) and the 3-month HRV between the two groups. At the one-year follow-up, there was no significant difference in rhythm outcomes between the two groups (Overall, Log-rank p = 0.885; anti-arrhythmic drug free, Log-rank p = 0.673). These efficacy and safety outcomes were consistently similar irrespective of the AF type or ablation lesion set. The Cox regression analysis showed that the left atrium volume index estimated by computed tomography (HR 1.01 [1.00-1.02]), p = 0.003) and extra-pulmonary vein triggers (HR 1.59 [1.03-2.44], p = 0.036) were independently associated with one-year clinical recurrence, whereas the HPSD ablation was not (HR 1.03 [0.73-1.44], p = 0.887). Conclusion: HPSD-AFCA notably reduced the procedure time with similar rhythm outcomes, complication rate, and influence on autonomic function as ConvP-AFCA, irrespective of the AF type or ablation lesion set.

| S-EPMC8530188 | biostudies-literature

Characteristics of Very High-Power, Short-Duration Radiofrequency Applications.

Project description:IntroductionPulmonary vein isolation is the cornerstone of rhythm-control therapy for atrial fibrillation (AF). The very high-power, short-duration (vHPSD) radiofrequency (RF) ablation is a novel technology that favors resistive heating while decreasing the role of conductive heating. Our study aimed to evaluate the correlations between contact force (CF), power, impedance drop (ID), and temperature; and to assess their role in lesion formation with the vHPSD technique.MethodsConsecutive patients who underwent initial point-by-point RF catheter ablation for AF were enrolled in the study. The vHPSD ablation was performed applying 90 W for 4 s with an 8 ml/min irrigation rate.ResultsData from 85 patients [median age 65 (59-71) years, 34% female] were collected. The median procedure time, left atrial dwelling time, and fluoroscopy time were 70 (60-90) min, 49 (42-58) min, and 7 (5-11) min, respectively. The median RF time was 312 (237-365) sec. No steam pop nor major complications occurred. A total of 6,551 vHPSD RF points were analyzed. The median of CF, maximum temperature, and ID were 14 (10-21) g, 47.6 (45.1-50.4) °C, and 8 (6-10) Ohms, respectively. CF correlated significantly with the maximum temperature (p < 0.0001). A CF of 5 g and above was associated with a significantly higher temperature compared to those lesions with a CF below 5 grams (p < 0.0001). Bilateral first-pass isolation rate was 84%. The 6-month AF-recurrence rate was 7%.ConclusionThe maximum temperature and CF significantly correlate with each other during vHPSD applications. A CF ≥ 5 g leads to better tissue heating and thus might be more likely to result in good lesion formation, although this clinical study was unable to assess actual lesion sizes.

| S-EPMC9326019 | biostudies-literature

Using computed tomogram atrial myocardial thickness maps in high‐power short‐duration radiofrequency pulmonary vein isolation: UTMOST AF

Project description: Not available

| S-EPMC10995596 | biostudies-literature

Comparison of high-power short-duration and low-power long-duration radiofrequency ablation for treating atrial fibrillation: Systematic review and meta-analysis.

Project description:BackgroundHigh power shorter duration (HPSD) ablation seen to increase efficacy and safety treating of atrial fibrillation (AF); however, comparative data between HPSD and low power longer duration (LPLD) ablation are limited.HypothesisWe thought that HPSD might bring more clinical benefits. The aim of this meta-analysis was to evaluate the clinical benefits of HPSD in patients with AF.MethodsThe Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and LPLD ablation.ResultsTen trials with 2467 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first-pass pulmonary vein isolation (PVI) (risk ratio [RR]: 1.20; 95% confidence interval [CI]: 1.10-1.31, P < .001) and recurrence of atrial arrhythmias (RR: 0.73; 95% CI: 0.58-0.91, P = .005). Additionally, HPSD could reduce procedural time (weighted mean difference [WMD]: -42.93; 95% CI, -58.10 to -27.75, P < .001), ablation time (WMD: -21.01; 95% CI: -24.55 to -17.47, P < .001), and fluoroscopy time (WMD: -4.11; 95% CI: -6.78 to -1.45, P < .001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44-1.30, P = .31) and (RR: 0.57; 95% CI: 0.21-1.51, P = .26).ConclusionsHPSD was safe and efficient for treating AF. Compared with LPLD, HPSD was associated with advantages of procedural features, higher first-pass PVI and reducing recurrence of atrial arrhythmias. Moreover, major complications and ETI were similar between two groups.

| S-EPMC7724222 | biostudies-literature

Optimal conditions for high-power, short-duration radiofrequency ablation using a novel, flexible-tipped, force-sensing catheter.

Project description:BackgroundHigh-power, short-duration (HPSD) radiofrequency ablation (RFA) reduces procedure time; however, safety and efficacy thresholds vary with catheter design.ObjectiveThe study sought to determine optimal HPSD ablation conditions with a novel flexible-tipped, contact force-sensing RFA catheter.MethodsRFA lesions were created in thigh muscle (16 swine) over a range of conditions (51-82 W, 2-40 g, 8-40 mL/min irrigation). An intracardiac study was performed (12 swine) to characterize steam pop thresholds. Lesions were created in a second intracardiac study (14 swine, n = 290 pulmonary vein isolation [PVI] lesions) with combinations of radiofrequency power, duration, and contact force. PVI was tested, animals were sacrificed, and lesions were measured.ResultsThe likelihood of coagulation formation in the thigh model was <20% when power was ≤79 W, when contact force was ≤40 g, when duration was ≤11 seconds, and when irrigation rates were 8 to 40 mL/min. The impact of contact force on lesion safety and efficacy was more pronounced using HPSD (60 W/8 seconds) compared with conventional ablation (30 W/45 seconds) (P = .038). During PVI, focal atrial lesions ranged in width from 4.2 to 12.5 mm and were transmural 80.8% of the time. PVI was achieved in 13 of 14 veins. Logistic regression identified that the optimal parameters for radiofrequency application were 60 to 70 W with a duration <8 seconds and <15 g contact force.ConclusionsOptimal HPSD lesions with this this flexible-tipped, force-sensing RFA catheter were created at 60 to 70 W for <8 seconds with <15 g contact force. Chronic studies are ongoing to assess radiofrequency parameter refinements and long-term lesion durability using these conditions.

| S-EPMC10373153 | biostudies-literature

Patient experience of very high power short duration radiofrequency ablation for atrial fibrillation under mild conscious sedation.

Project description:BackgroundVery high power short duration (vHPSD) radiofrequency ablation (RFA) may reduce ablation times and improve patient tolerability, permitting pulmonary vein isolation (PVI) under mild conscious sedation (mCS) and promoting same day discharge (SDD).MethodsFirst, a retrospective feasibility study was performed at 2 tertiary cardiac centres in the UK. Consecutive cases of first-time PVI using vHPSD ablation with 90 W lesions for up to 4 s were compared against cases performed using standard RF (sRF) and cryoballoon (Cryo) therapy. Subsequently, a prospective study of patients who had vHPSD or Cryo exclusively under mCS was undertaken. Questionnaires based on Likert and visual analogue scales (VAS) were used to measure anxiety, discomfort and pain.ResultsIn total, 182 patients (59 vHPSD, 62 sRF and 61 Cryo) were included in the retrospective study, with 53 (90%) of vHPSD cases successfully performed under mCS. PVI ablation time in the vHPSD group (5.8 ± 1.7 min) was shorter than for sRF (16.5 ± 6.3 min, p < 0.001) and Cryo (17.5 ± 5.9 min, p < 0.001). Fifty-one vHPSD and 52 Cryo patients were included in the prospective study. PVI ablation time in the vHPSD group was shorter than for the Cryo group (6.4 ± 2.9 min vs 17.9 ± 5.7 min, p < 0.001), but overall procedure duration was longer (121 ± 39 min vs 95 ± 20 min, p < 0.001). There were no differences in the patient experience of anxiety, discomfort or pain. SDD rates were the same in both groups (61% vs 67%, p = 0.49).ConclusionsvHPSD RFA for PVI can be performed under mCS to achieve SDD rates comparable to cryoablation, without compromising patient experience.

| S-EPMC9396586 | biostudies-literature

Revisiting symptomatic pulmonary vein stenosis after high-power short-duration radiofrequency ablation in patients with atrial fibrillation.

Project description: Not available

| S-EPMC10558058 | biostudies-literature

The superiority of high-power short-duration radiofrequency catheter ablation strategy for atrial fibrillation treatment: A systematic review and meta-analysis study.

Project description:BackgroundRadiofrequency catheter ablation (RFCA) using the high-power short duration (HPSD) results in better ablation lesion formation in the swine model. This systematic review and meta-analysis purposed to investigate the safety and efficacy profile between HPSD and low-power long-duration (LPLD) ablation strategies to treat atrial fibrillation (AF) patients.MethodsWe completed the literature review after identifying the relevant articles comparing HPSD and LPLD ablation methods for AF recorded in ClinicalTrials.com, CENTRAL, PubMed, and ScienceDirect until February 2021. The overall effects were calculated using pooled risk ratio (RR) and mean difference (MD) for categorical and continuous data, respectively. We also estimated the 95% confidence interval (CI).ResultsThe HPSD strategy took shorter procedure time (MD = -33.75 min; 95% CI = -44.54 to -22.97; P < .01), fluoroscopy time (MD = -5.73 min; 95% CI = -8.77 to -2.70; P < .001), and ablation time (MD = -17.71; 95% CI = -21.02 to -14.41) than LPLD strategy. The HPSD RFCA was correlated with lower risk of esophageal thermal injury (RR = 0.75; 95% CI = 0.59 to 0.94; P = .02). The HPSD method resulted in higher first-pass pulmonary vein isolation (PVI) (RR = 1.36; 95% CI = 1.13 to 1.64; P < .01), lower PV reconnection (RR = 0.47; 95% CI = 0.34 to 0.64; P < .01), and lower recurrent AF (RR = 0.72; 95% CI = 0.54 to 0.96; P = .02) than LPLD strategy.ConclusionHPSD RFCA was superior to the conventional LPLD RFCA in terms of safety and efficacy in treating AF patients.

| S-EPMC8339091 | biostudies-literature

High-power short-duration versus standard-power standard-duration settings for repeat atrial fibrillation ablation.

Project description:IntroductionHigh-power short-duration (HPSD) ablation is a novel strategy using contact force-sensing catheters optimized for radiofrequency ablation for atrial fibrillation (AF). No study has directly compared HPSD versus standard-power standard-duration (SPSD) contact force-sensing settings in patients presenting for repeat ablation with AF recurrence after initial ablation.MethodsWe studied consecutive cases of patients with AF undergoing repeat ablation with SPSD or HPSD settings after their initial pulmonary vein isolation (PVI) with temperature controlled non-contact force, SPSD or HPSD settings between 6/23/14 and 3/4/20. Procedural data collected included radiofrequency ablation delivery time (RADT). Clinical data collected include sinus rhythm maintenance post-procedure.ResultsA total of 61 patients underwent repeat ablation (36 SPSD, 25 HPSD). A total of 51 patients (83.6%) were found to have pulmonary vein reconnections necessitating repeat isolation, 10 patients (16.4%) had durable PVI and ablation targeted non-PV sources. RADT was shorter when comparing repeat ablation using HPSD compared to SPSD (22 vs 35 min; p = 0.01). There was no difference in sinus rhythm maintenance by Kaplan-Meier survival analysis (log rank test p = 0.87), after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume index, CHA2DS2-VASc score, or left ventricular ejection fraction.ConclusionWe demonstrated that repeat AF ablation with HPSD reduced procedure times with similar sinus rhythm maintenance compared to SPSD in those presenting for repeat ablation.

| S-EPMC9114024 | biostudies-literature

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