High-Power Short-Duration Ablation of Paroxysmal and Persistent Atrial Fibrillation

Figures

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  Fig. 1.. Impact of Low-Power Long-Duration and High-Power Short-Duration Techniques on Tissue Heating. Low-power long-duration (LPLD) ablation increases the conductive heating to adjacent tissues, such as the esophagus, while the resistive heating is limited (A). Conversely, high-power short-duration (HPSD) ablation increases the resistive heating while decreasing the conductive heating, potentially reducing the risk of thermal injury (B).

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  Fig. 2.. Voltage map of the left atrium showing pulmonary vein isolation (PVI) with QDOT MICRO𝐓𝐌 catheter (Biosense Webster, Inc. Irvine, CA, USA). Abbreviations: LPV, left pulmonary veins; Eso, esophagus; RPV, right pulmonary veins; RPN, right phrenic nerve; LAA, left atrial appendage; PW, posterior wall. Used with permission from Cardiotext Publishing. Amin Al-Ahmad. Hands-On Ablation: The Expert’s Approach. Third Edition. Minneapolis, MN: Cardiotext; December 2022.

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  Fig. 3.. Comparing Ablation Strategies in Atrial Fibrillation: 50 W-HPSD vs. 40 W-HPSD - Procedural Efficiency and Outcomes. 50 W-HPSD ablation was associated with a significantly shorter ablation and procedural time compared to 40 W-HPSD ablation (A, B). The rate of first-pass isolation was significantly higher in the 50 W-HPSD ablation group than in the 40 W-HPSD ablation group (C). No difference was observed in maximum esophageal temperature and acute complications between groups (D, E). Abbreviations: HPSD, high-power short-duration; Min, minutes; PVI, pulmonary vein isolation; RF, radiofrequency; Max. Esoph. Tempe, maximal esophageal temperature. Used with permission from Elsevier. Costea et al. 50 W vs. 40 W During High-Power Short-Duration Ablation for Paroxysmal Atrial Fibrillation: A Multicenter Prospective Study. Journal of the American College of Cardiology: Clinical Electrophysiology. in PRESS.

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  Fig. 4.. Target impedance drop of 10 ohms and contact force of 15 g achieved with 50 W-HPSD ablation. Abbreviations: LAA, left atrial appendage; LPV, left pulmonary veins; PW, posterior wall; RPV, right pulmonary veins; HPSD, high-power short-duration. Used with permission from Cardiotext Publishing. Amin Al-Ahmad. Hands-On Ablation: The Expert’s Approach. Third Edition. Minneapolis, MN: Cardiotext; December 2022.

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  Fig. 5.. Voltage map showing left atrial appendage electrical isolation. Abbreviations: LCx, left circumflex; LPN, left phrenic nerve. Reprinted from JACC: EP. 2020; 6: 157–167. Romero et al. Imaging Integration to Localize and Protect the Left Coronary Artery in Patients Undergoing LAAEI, with permission from Elsevier.