Key result
Multiple radiofrequency ablations at the same location offered no meaningful benefit in lesion depth or width over single ablations, except for ventricular ablation at 30 W for 50 s.
Why the study?
In radiofrequency ablation procedures for cardiac arrhythmia, the efficacy of creating repeated lesions at the same location remains poorly studied.
Does creating repeated radiofrequency ablation lesions at the same location increase lesion depth or width in ex vivo cardiac tissue?
Does creating repeated radiofrequency ablation lesions at the same location increase lesion depth or width in ex vivo cardiac tissue?
Creating repeated 'insurance' lesions at the same location during radiofrequency ablation offers no meaningful benefit in lesion dimensions over single ablations, except under specific ventricular ablation parameters.
INTRODUCTION: In radiofrequency ablation procedures for cardiac arrhythmia, the efficacy of creating repeated lesions at the same location ("insurance lesions") remains poorly studied. We assessed the effect of type of tissue, power, and time on the resulting lesion geometry during such multiple ablation procedures. METHODS: A custom ex vivo ablation model was used to assess lesion formation. An ablation catheter was oriented perpendicular to the tissue and used to create lesions that varied by type of tissue (atrial or ventricular free wall), power (30 or 50 W), and time (30, 40, or 50 s for standard ablations and 5, 10, or 15 s for high-power, short-duration [HPSD] ablations). Lesion dimensions were recorded and then analyzed. Radiofrequency ablations were performed on 57 atrial tissue samples (28 HPSD, 29 standard) and 28 ventricular tissue samples (all standard). RESULTS: With ablation parameters held constant, performing multiple ablations significantly increased lesion depth in ventricular tissue when ablations were performed at 30 W for 50 s. No other set of ablation parameters was shown to affect the width or depth of the resulting lesions in either tissue type. CONCLUSION: Multiple ablations created with the same power and time, delivered within 30 s of each other at the same exact location, offer no meaningful benefit in lesion depth or width over single ablations, with the exception of ventricular ablation at 30 W for 50 s. Given the risks associated with excessive ablation, our results suggest that this practice should be re-evaluated by clinical electrophysiologists.
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Toloczko et al. (2022) studied Cardiac arrhythmia (n=85). Multiple radiofrequency ablations ('insurance lesions') vs. Single ablations was evaluated on Lesion depth and width. Multiple radiofrequency ablations at the same location offered no meaningful benefit in lesion depth or width over single ablations, except for ventricular ablation at 30 W for 50 s.
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