Key result
Single high-power AI-550 ablation creates ~11% deeper lesions than double-application vHPSD plus AI-450.
Why the study?
Does a single high-power application with a higher target ablation index create deeper lesions compared to a double application strategy following vHPSD in thick myocardial regions?
Does a single high-power application with a higher target ablation index create deeper lesions compared to a double application strategy following vHPSD in thick myocardial regions?
A single high-power RF application with a higher target ablation index is more effective for creating deep lesions in thick myocardium than repeating vHPSD or combining it with moderate AI-guided ablation.
Answers are grounded in this paper and cite their sources.
Single high-power AI 550 application may optimize lesion depth in thick myocardium; hypothesis-generating in animal models, human trials needed.
BACKGROUND: A very high-power short-duration (vHPSD) radiofrequency (RF) ablation creates shallower lesions, which may be insufficient in thick myocardial regions. AIMS: To clarify an effective ablation strategy following the initial vHPSD application and determine the best approach to create sufficient lesion depth in thick myocardial regions using ex vivo and in vivo models. METHODS: Lesion metrics were compared under various settings: 35 W versus 50 W with the same target ablation index (AI) (Step 1); double vHPSD ablations versus vHPSD followed by AI-guided ablation (Step 2); double applications (DA) with vHPSD followed by AI-guided ablation with a target AI of 450 versus single application (SA) with a target AI of 550 at 50 W (Step 3). RESULTS: Lesion depth was comparable between groups with the same AI but different RF powers. Lesions were significantly deeper in the vHPSD ablation followed by a target AI of 450 compared to double vHPSD ablations (vHPSD + vHPSD, 3.4 [3.1-3.6] mm; vHPSD + AI 450 at 35 W, 4.4 [4.1-4.9] mm; vHPSD + AI 450 at 50 W, 4.5 [4.1-4.9] mm, p < 0.001). High-power SA with a target AI of 550 created significantly deeper lesions than vHPSD + AI 450 (DA vs. SA, 4.5 [3.5-5.3] mm vs. 5.0 [4.1-5.9] mm, p = 0.01). CONCLUSIONS: AI-guided RF applications following vHPSD effectively increased lesion depth more than repeated vHPSD. However, a single high-power application targeting a higher AI resulted in the deepest lesions. This strategy may be particularly beneficial in thick atrial myocardial regions to enhance lesion durability and improve procedural outcomes.
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Iwakawa et al. (2025) studied Preclinical model for radiofrequency ablation (n=8). Single high-power radiofrequency application (target AI 550 at 50 W) vs. Double application (vHPSD followed by AI 450 at 50 W) was evaluated on Lesion depth (p=0.01). A single high-power radiofrequency application targeting an ablation index of 550 created significantly deeper lesions (5.0 mm) compared to a double application strategy of vHPSD followed by an ablation index of 450 (4.5 mm, p=0.01).
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