Key result
Higher power local impedance-guided ablation achieves a ~14% larger maximum impedance drop versus lower power.
Why the study?
Because local impedance reflects tissue characteristics, the efficacy of higher power compared to lower power in local impedance-guided ablation may differ from other index-guided ablations.
Does higher power radiofrequency ablation improve local impedance drop and transmural lesion formation compared to lower power in patients undergoing atrial fibrillation ablation?
Does higher power radiofrequency ablation improve local impedance drop and transmural lesion formation compared to lower power in patients undergoing atrial fibrillation ablation?
Absolute Event Rate: 28.3% vs 24.8%
Higher power settings during local impedance-guided ablation for atrial fibrillation result in larger impedance drops and shorter ablation times, suggesting more effective transmural lesion formation.
May support optimized lesion metrics with higher power in impedance-guided AF ablation; hypothesis-generating for clinical outcomes.
BACKGROUND: Since the local impedance (LI) of the ablation catheter reflects tissue characteristics, the efficacy of higher power (HP) compared to lower power (LP) in LI-guided ablation may differ from other index-guided ablations. OBJECTIVE: This study aimed to assess the efficacy of HP ablation in LI-guided ablation of atrial fibrillation (AF). METHODS: Mapping System and an open-irrigated ablation catheter with mini-electrodes (IntellaNav MIFI OI). Ablation was stopped when the LI drop reached 30 ohms, three seconds after the LI plateaued, or when ablation time reached 30 s. To balance the baseline differences, a unique method was used in which the power was changed between HP (45 W to anterior wall/40 W to posterior wall) and LP (35 W/30 W) alternately for each adjacent point. RESULTS: A total of 551 ablations in 10 patients were analyzed (HP, n = 276; LP, n = 275). The maximum LI drop was significantly larger (HP: 28.3 ± 5.4 vs. LP: 24.8 ± 6.3 ohm), and the time to minimum LI was significantly shorter (HP: 15.0 ± 6.3 vs. LP: 19.3 ± 6.6 s) in the HP setting. The unipolar electrogram analysis of three patients revealed that the electrogram indicating transmural lesion formation was observed more frequently in the HP setting. CONCLUSION: In LI-guided ablation, the HP could achieve a larger LI drop and shorter time to minimum LI, which may result in more transmural lesion formation compared to a LP setting.
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Yamashita et al. (2023) studied Atrial fibrillation (n=10). Higher power local impedance-guided ablation vs. Lower power ablation (35 W / 30 W) was evaluated on Maximum local impedance drop (ohms). Higher power local impedance-guided ablation achieved a significantly larger maximum impedance drop (28.3 vs 24.8 ohms) and shorter time to minimum impedance (15.0 vs 19.3 s) than lower power.
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