Key result
High-power (40 W) radiofrequency ablation yielded significantly lower maximum tissue temperatures than 20 W ablation under the same lesion size index (40.0°C vs 42.8°C, P=.003) in an ex vivo model.
Why the study?
Although ablation index and lesion size index predict lesion quality, collateral damage remains a concern, prompting comparison of lesion characteristics and tissue temperatures between 20 W and 40 W settings.
Does a 40 W radiofrequency power setting compared to 20 W alter tissue temperature profiles and collateral thermal damage in an ex vivo swine myocardium model under the same ablation index and lesion size index?
Does a 40 W radiofrequency power setting compared to 20 W alter tissue temperature profiles and collateral thermal damage in an ex vivo swine myocardium model under the same ablation index and lesion size index?
A high power setting (40 W) based on the ablation index and lesion size index may reduce collateral thermal damage compared to a lower power setting (20 W) due to differing tissue temperature profiles.
Supports hypothesis of lower peak temperatures with 40 W at fixed lesion size index in ex vivo models; leaves open in vivo translation and clinical safety.
INTRODUCTION: The ablation index (AI) and lesion size index (LSI) are novel markers for predicting the ablation lesion quality, however, collateral damage is still a concern. This study aimed to compare the lesion characteristics and tissue temperature profiles between 20 W (20 Ws) and 40 W (40 Ws) ablation settings under the same AI and LSI. METHODS: An ex vivo model consisting of swine myocardium (5-6 mm thickness) in a circulating, warmed saline bath was used. Twenty-one tissue temperature electrodes were used. Radiofrequency applications with different power settings were performed with a 10 to 12 g contact force until the AI and LSI reached 350 and 4.5, respectively. RESULTS: A total of 120 radiofrequency (RF) applications and 2520 tissue temperature profiles were analyzed. The speed of the tissue temperature rise with 40 Ws was significantly faster than that with 20 Ws. However, the maximum tissue temperature did not significantly differ between 20 and 40 Ws with the same AI (44.6°C ± 3.9°C vs 45.1°C ± 6.4°C, P = .73), and was significantly lower for 40 Ws with the same LSI (42.8°C ± 3.4°C vs 40.0°C ± 3.4°C, P = .003). For both the AI and LSI, the number of electrodes exhibiting high temperatures (≥39°C) was significantly larger and the duration of high tissue temperatures was significantly longer with 20 Ws. The thermal latency with 40 Ws was greater. CONCLUSIONS: Although the targeted AI and LSI were the same for both 20 and 40 Ws, the tissue temperature profiles differed greatly depending on the RF power setting. A high power setting based on the AI and LSI may reduce the collateral thermal damage.
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Takemoto et al. (2019) studied Radiofrequency ablation. Radiofrequency ablation at 40 W vs. Radiofrequency ablation at 20 W was evaluated on Maximum tissue temperature with the same LSI (p=.003). High-power (40 W) radiofrequency ablation yielded significantly lower maximum tissue temperatures than 20 W ablation under the same lesion size index (40.0°C vs 42.8°C, P=.003) in an ex vivo model.
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