Key result
Very-high-power short-duration 90W ablation produces smaller lesions than high-power short-duration ablation.
Why the study?
High-power short-duration ablation has been proposed to shorten procedure times while maintaining efficacy and safety, but differences in lesion size and geometry compared to conventional ablation were evaluated.
Does very-high-power short-duration ablation alter lesion size and geometry compared to conventional and high-power short-duration ablation in porcine left ventricle?
Does very-high-power short-duration ablation alter lesion size and geometry compared to conventional and high-power short-duration ablation in porcine left ventricle?
VHPSD lesions with the QDot-Micro catheter are smaller and shallower than HPSD or conventional lesions, which may be advantageous for posterior left atrial wall ablation.
Smaller VHPSD lesions than HPSD in porcine LV; leaves open translation to safer human posterior wall ablation.
Introduction High‐power short‐duration (HPSD) has been proposed to shorten procedure times while maintaining efficacy and safety. We evaluated the differences in size and geometry between radiofrequency lesions obtained with this method and conventional ones. Methods and Results Twenty‐eight sets of 10 perpendicular radiofrequency applications were performed with two commercially available catheters: a temperature‐controlled HPSD catheter (QDot‐Micro) and a conventional power‐controlled catheter (Thermocool SmartTouch) on porcine left ventricle. Different power settings (35, 40, 50, and 90 W), contact force (CF; 10 and 20 g), ablation index (AI; 400 and 550), and application times were combined to create conventional (35–40 W), HPSD (50 W) and very‐high‐power short‐duration (VHPSD; 90 W) lesions, that were cross‐sectioned and measured. About 4‐s VHPSD lesions were smaller, shallower, and thinner than HPSD performed with the QDot‐Micro catheter in any scenario of CF or AI (61 ± 7.8 mm 3 , 6.1 ± 0.3 mm wide, and 2.9 ± 0.1 mm deep with 10 g; 72.2 ± 0.5 mm 3 , 6.8 ± 0.3 mm wide, and 2.9 ± 0.2 mm deep with 20 g). Conventional and HPSD lesions performed with the temperature‐controlled catheter were generally bigger, deeper, and wider than the ones obtained with the power‐controlled catheter, as well as more consistent in size. This was especially true with the lower CF and AI scenario, while differences were less notable with other setting combinations. Conclusion VHPSD lesions performed with QDot‐Micro catheter were smaller than any other lesions, which is especially attractive for posterior left atrial wall ablation. On the contrary, conventional‐powered and HPSD lesions performed with this catheter were equally sized (or even bigger with lower CF and AI objectives), as well as more consistent in size, which would guarantee transmurality in other locations.
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Granero et al. (2022) studied Radiofrequency ablation lesions. Temperature-controlled catheter (QDot-Micro) vs. Conventional power-controlled catheter (Thermocool SmartTouch) was evaluated on Lesion size and geometry (volume, width, depth). Very-high-power short-duration (90 W) lesions using the QDot-Micro catheter were smaller (61 ± 7.8 mm3 at 10 g contact force) than high-power short-duration lesions.
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