Temperature- and flow-controlled ablation/very-high-power short-duration ablation vs conventional power-controlled ablation: Comparison of focal and linear lesion characteristics.

Takigawa, Masateru; Kitamura, Takeshi; Martin, Claire A; Fuimaono, Kristine; Datta, Keshava; Joshi, Helee; Constantin, Marion; Bourier, Felix; Cheniti, Ghassen; Duchateau, Josselin; Pambrun, Thomas; Denis, Arnaud; Derval, Nicolas; Sacher, Frederic; Cochet, Hubert; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre

doi:10.1016/j.hrthm.2020.10.021

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2021

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Title:: Temperature- and flow-controlled ablation/very-high-power short-duration ablation vs conventional power-controlled ablation: Comparison of focal and linear lesion characteristics.
Document type:: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
Author(s):: Takigawa, Masateru; Kitamura, Takeshi; Martin, Claire A; Fuimaono, Kristine; Datta, Keshava; Joshi, Helee; Constantin, Marion; Bourier, Felix; Cheniti, Ghassen; Duchateau, Josselin; Pambrun, Thomas; Denis, Arnaud; Derval, Nicolas; Sacher, Frederic; Cochet, Hubert; Hocini, Mélèze; Haïssaguerre, Michel; Jaïs, Pierre
Abstract:: BACKGROUND: The QDOT MICRO catheter allows temperature- and flow-controlled (TFC) ablation and very-high-power short-duration (vHPSD) ablation. OBJECTIVE: The purpose of this study was to compare lesion characteristics between TFC/vHPSD ablation and standard power-controlled (PC) ablation. METHODS: Lesion characteristics in the right atrium, left atrium, and right ventricle (RV) of 6 sheep were compared between vHPSD (90 W/4 seconds, TC mode with 60°C target using QDOT) and standard radiofrequency settings (PC mode, 30 W/30 seconds with ThermoCool SmartTouch SF). Lesions in the left ventricle (LV) were compared, targeting 50 W for 60-second applications. RESULTS: Forty-six focal atrial lesions, 50 RV focal lesions, and 12 linear lesions were created by vHPSD ablation and PC ablation in each group of 6 animals. vHPSD ablation produced significantly larger focal atrial lesions in length (8.3 [6.4-9.7] mm vs 6.3 [5.2-7.4] mm; P = .0002), width (6.0 [5.3-6.9] mm vs 4.6 [3.8-5.4] mm; P <.0001), and surface area (39.4 [25.4-52.4] mm2 vs 23.6 [16.0-31.1] mm2; P = .0001), with superior transmurality (89.1% vs 69.6%; P = .04) compared to PC ablation. vHPSD ablation produced significantly larger RV lesions in length (7.7 [7.0-8.7] mm vs 6.0 [4.8-6.9] mm; P <.0001), width (6.4 [5.4-7.5] mm vs 4.3 [3.6-5.2] mm; P <.0001), and area (39.4 [29.1-50.1] mm2 vs 19.9 [14.7-25.2] mm2; P <.0001) but similar volume (P = .97) with shallower lesions (2.7 [2.2-3.4] mm vs 3.8 [3.0-4.4] mm; P <.0001). Atrial linear lesions were more homogeneous (P = .02), with fewer gaps in each line (P = .003) with vHPSD ablation. LV focal lesions (15 TFC mode; 21 PC mode) were similar in volume and depth, but lesion size showed less deviation (P <.05) in TFC than PC mode. Fewer steam pops were observed in TFC mode (0% vs 28.6%; P = .03). Hemorrhagic rings around the lesion core were generally smaller with TFC/vHPSD ablation (P <.05). CONCLUSION: TFC/vHPSD ablation produces larger, shallower, more homogeneous, and less hemorrhagic lesions. vHPSD Ablation produces more transmural and contiguous linear lesions compared to PC ablation. LV lesions are more homogeneous with fewer steam pops in TFC ablation.
Journal title abbreviation:: Heart Rhythm
Year:: 2021
Journal volume:: 18
Journal issue:: 4
Pages contribution:: 553-561
Fulltext / DOI:: doi:10.1016/j.hrthm.2020.10.021
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/33127542
Print-ISSN:: 1547-5271
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2021