Why the study?
High-power short-duration RFCA has recently been suggested as safer and more effective than standard low-power long-duration settings, but their electrical and thermal performance and the effect of catheter orientation needed comparison.
Does high-power short-duration radiofrequency ablation alter lesion characteristics and safety compared to standard settings in an in-silico model?
Does high-power short-duration radiofrequency ablation alter lesion characteristics and safety compared to standard settings in an in-silico model?
In an in-silico model, high-power short-duration ablation creates shallower and wider lesions compared to standard settings, which may be beneficial for procedures like pulmonary vein isolation, though it carries an earlier risk of steam pops.
HPSD may optimize lesion geometry for PVI yet heighten early steam pop risk; animal data leave clinical translation open.
PURPOSE: While the standard setting during radiofrequency catheter ablation (RFCA) consists of applying low power for long times, a new setting based on high power and short duration (HPSD) has recently been suggested as safer and more effective. Our aim was to compare the electrical and thermal performance of standard vs. HPSD settings, especially to assess the effect of the catheter orientation. METHODS: A 3D computational model was built based on a coupled electric-thermal-flow problem. Standard (20 W-45 s and 30 W-30 s) and HPSD settings (70 W-7 s and 90 W-4 s) were compared. Since the model only included a cardiac tissue fragment, the power values were adjusted to 80% of the clinical values (15, 23, 53 and 69 W). Three catheter-tissue orientations were considered (90°, 45° and 0°). Thermal lesions were assessed by the Arrhenius equation. Safety was assessed by checking the occurrence of steam pops (100 °C in tissue) and thrombus formation (80 °C in blood). RESULTS: studies. HPSD created shallower and wider lesions than standard settings, especially with the catheter at 45°. Steam pops occurred earlier with HPSD, regardless of catheter orientation. CONCLUSION: HPSD seems to be more effective in cases that need shallow and extensive lesions, especially when the catheter is at 0° or at 45°, as used in pulmonary vein isolation.
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Coderch-Navarro et al. (2021) studied this question.
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