Abstract
BackgroundTransmural lesion creation is essential for effective atrial fibrillation (AF) ablation. Lesion characteristics between conventional energy and high-power short-duration (HPSD) setting in contact force-guided (CF) ablation for AF remained unclear.MethodsEighty consecutive AF patients who received CF with conventional energy setting (power control: 25–30 W, force–time integral = 400 g s, n = 40) or with HPSD (power control: 40–50 W, 10 s, n = 40) ablation were analyzed. Of them, 15 patients in each conventional and HPSD group were matched by age and gender respectively for ablation lesions analysis. Type A and B lesions were defined as a lesion with and without significant voltage reduction after ablation, respectively. The anatomical distribution of these lesions and ablation outcomes among the 2 groups were analyzed.Results1615 and 1724 ablation lesions were analyzed in the conventional and HPSD groups, respectively. HPSD group had a higher proportion of type A lesion compared to conventional group (P < 0.01). In the conventional group, most type A lesions were at the right pulmonary vein (RPV) posterior wall (50.2%) whereas in the HPSD group, most type A lesions were at the RPV anterior wall (44.0%) (P = 0.04). The procedure time and ablation time were significantly shorter in the HPSD group than that in the conventional group (91.0 ± 12.1 vs. 124 ± 14.2 min, P = 0.03; 30.7 ± 19.2 vs. 57.8 ± 21 min, P = 0.02, respectively). At a mean follow-up period of 11 ± 1.4 months, there were 13 and 7 patients with recurrence in conventional and HPSD group respectively (P = 0.03).ConclusionOptimal ablation lesion characteristics and distribution after conventional and HPSD ablation differed significantly. HPSD ablation had shorter ablation time and lower recurrence rate than did conventional ablation.
Highlights
Complete and durable pulmonary vein (PV) isolation (PVI) with point-by-point adjacent transmural lesion creation is essential in effective atrial fibrillation (AF) ablation [1]
The proportion of ablation lesion types among the groups is illustrated in Fig. 3A: the proportion of type A lesions was significantly higher in the high-power short-duration (HPSD) group than in the conventional group (82.0% vs. 72.1%, P < 0.01)
(5) HPSD ablation led to a shorter ablation time and less recurrence rate than did conventional ablation
Summary
Complete and durable pulmonary vein (PV) isolation (PVI) with point-by-point adjacent transmural lesion creation is essential in effective atrial fibrillation (AF) ablation [1]. Contact force-guided (CF) ablation for PVI provides improved clinical outcomes [3, 4]: a force time integral (FTI) of > 392 g s potentially predicts effective creation of transmural lesion [5]. Local bipolar electrogram (EGM) voltage is related to the thickness of the atrial musculature. An increase in this voltage indicates conduction gap after linear ablation in the left atrium [11], whereas a significant decrease in this voltage indicates transmural lesion creation during AF ablation [12]. Lesion characteristics between conventional energy and high-power short-duration (HPSD) setting in contact force-guided (CF) ablation for AF remained unclear
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