Key result
High-power short-duration RF applications of 50 W (11-13s) and 60 W (8-10s) resulted in equivalent lesion metric indices compared with conventional 30 W, 30-second ablations.
Why the study?
Lesion metric indices support pulmonary vein isolation and correlate with lesion sizes, but a detailed analysis of RF settings—including HPSD settings—and resulting lesion metric indices was needed.
Do high-power short-duration RF settings produce equivalent lesion metric indices compared to conventional RF settings in an in silico model?
Do high-power short-duration RF settings produce equivalent lesion metric indices compared to conventional RF settings in an in silico model?
In silico modeling demonstrates that high-power short-duration RF ablation settings (50W/11-13s or 60W/8-10s) yield equivalent lesion metric indices to conventional 30W/30s settings, supporting their clinical use.
HPSD settings (50 W/11-13 s, 60 W/8-10 s) yield equivalent lesion indices to conventional ablation; leaves open clinical translation in PVI.
BACKGROUND: Use of lesion metric indices is a proposed strategy to support pulmonary vein isolation procedures and these indices show good correlations with lesion sizes. The aim of this in silico study is to provide a detailed analysis of radiofrequency (RF) settings, including high-power short-duration (HPSD) settings, and resulting lesion metric indices. METHODS AND RESULTS: A software program was designed which simulated virtual RF ablations. Lesion metric indices (Ablation index: AI, Lesion size index: LSI) were calculated based on underlying RF settings (contact force [CF], power, duration). In series of calculations, the applied settings were varied within defined ranges (CF: 1-80 g, power: 1-60 W, duration: 1-60 seconds). Overall, n = 388 000 virtual ablations were calculated. The resulting lesion metric indices were compared with each other and analyzed in relation to respective RF settings. Increasing contact force from 1 to 10 g resulted in a 4.4-fold LSI value, whilst increasing contact force from 10 to 20g resulted in a 1.5-fold value (P < .01). When RF power was increased by 10 W, lesion metric indices increased between 1.3- and 1.6-fold. A prolongation of RF duration by 10 seconds resulted in a 1.2-to-1.3-fold increase of lesion metric indices. HPSD RF applications of 50 W, 11 to 13 seconds, and 60 W, 8 to 10 seconds resulted in equivalent lesion metric indices when compared with 30 W, 30 seconds conventional ablations. CONCLUSIONS: The findings support the clinical use of contact forces within a 10 to 20 g range. AI is more sensitive to RF duration, whereas LSI is more sensitive to contact force. HPSD RF settings can successfully be derived from lesion metric indices.
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Bourier et al. (2020) studied Pulmonary vein isolation (n=388,000). High-power short-duration (HPSD) RF ablation vs. Conventional ablation (30 W for 30 seconds) was evaluated on Lesion metric indices (Ablation index and Lesion size index). High-power short-duration RF applications of 50 W (11-13s) and 60 W (8-10s) resulted in equivalent lesion metric indices compared with conventional 30 W, 30-second ablations.
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