High-power short-duration ablation reached significantly higher maximum tissue temperatures than standard ablation (62.7 vs. 52.7°C, p=0.033) and achieved lethal temperatures faster.
Does 50 W high-power short-duration ablation compared to 30 W standard ablation affect tissue temperatures and lesion transmurality in an animal model?
In an animal model, AI-guided HPSD ablation achieved higher tissue temperatures and greater transmurality than standard ablation without increasing esophageal injury rates.
Absolute Event Rate: 62.7% vs 52.7%
p-value: p=0.033
BACKGROUND: Actual in vivo tissue temperatures and the safety profile during high-power short-duration (HPSD) ablation of atrial fibrillation have not been clarified. METHODS: We conducted an animal study in which, after a right thoracotomy, we implanted 6-8 thermocouples epicardially in the superior vena cava, right pulmonary vein, and esophagus close to the inferior vena cava. We recorded tissue temperatures during a 50 W-HPSD ablation and 30 W-standard ablation targeting an ablation index (AI) of 400 (5-15 g contact force). RESULTS: Maximum tissue temperatures reached with HSPD ablation were significantly higher than that reached with standard ablation (62.7 ± 12.5 vs. 52.7 ± 11.4°C, p = 0.033) and correlated inversely with the distance between the catheter tip and thermocouple, regardless of the power settings (HPSD: r = -0.71; standard: r = -0.64). Achievement of lethal temperatures (≥50°C) was within 7.6 ± 3.6 and 12.1 ± 4.1 s after HPSD and standard ablation, respectively (p = 0.003), and was best predicted at cutoff points of 5.2 and 4.4 mm, respectively. All HPSD ablation lesions were transmural, but 19.2% of the standard ablation lesions were not (p = 0.011). There was no difference between HPSD and standard ablation regarding the esophageal injury rate (30% vs. 33.3%, p > 0.99), with the injury appearing to be related to the short distance from the catheter tip. CONCLUSIONS: Actual tissue temperatures reached with AI-guided HPSD ablation appeared to be higher with a greater distance between the catheter tip and target tissue than those with standard ablation. HPSD ablation for <7 s may help prevent collateral tissue injury when ablating within a close distance.
Otsuka et al. (Fri,) conducted a other in Atrial fibrillation. High-power short-duration (HPSD) ablation vs. Standard ablation (30 W targeting an ablation index of 400) was evaluated on Maximum tissue temperatures (p=0.033). High-power short-duration ablation reached significantly higher maximum tissue temperatures than standard ablation (62.7 vs. 52.7°C, p=0.033) and achieved lethal temperatures faster.
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