Difference in Radiofrequency Ablation Profile Between During Sinus Rhythm and Atrial Fibrillation: Considerations in This Era of High-power Short-duration Strategy

Overview

Journal J Arrhythm

Publisher Wiley

Date 2024 Jun 28

PMID 38939764

Authors

Satoshi Hara

Shigeki Kusa

Yoshikazu Sato

Hiroaki Ohya

Naoyuki Miwa

Hidenori Hirano

Taiki Ishizawa

Tadanori Nakata

Junichi Doi

Hitoshi Hachiya

Affiliations

Soon will be listed here.

Abstract

Background: The concept of ablation index (AI) was introduced to evaluate radiofrequency (RF) ablation lesions. It is calculated from power, contact force (CF), and RF duration. However, other factors may also affect the quality of ablation lesions. To examine the difference in RF lesions made during sinus rhythm (SR) and atrial fibrillation (AF).

Methods: Sixty patients underwent index pulmonary vein isolation during SR ( = 30, SR group) or AF ( = 30, AF group). All ablations were performed with a power of 50 W, a targeted CF of 5-15 g, and AI of 400-450 using Thermocool Smarttouch SF. The CF, AI, RF duration, temperature rise (Δtemp), impedance drop (Δimp), and the CF stability of each ablation point quantified as the standard deviation of the CF (CF-SD) were compared between the two groups.

Results: A total of 3579 ablation points were analyzed, which included 1618 and 1961 points in the SR and the AF groups, respectively. Power, average CF, RF duration per point, and the resultant AI (389 ± 59 vs. 388 ± 57) were similar for the two rhythms. However, differences were seen in the CF-SD (3.5 ± 2.2 vs. 3.8 ± 2.1 g, < .01), Δtemp (3.8 ± 1.3 vs. 4.0 ± 1.3°C, < .005), and Δimp (10.3 ± 5.8 vs. 9.4 ± 5.4 Ω, < .005).

Conclusions: Despite similar AI, various RF parameters differed according to the underlying atrial rhythm. Ablation delivered during SR demonstrated less CF variability and temperature increase and greater impedance drop than during AF.

References

Delgado V, Di Biase L, Leung M, Romero J, Tops L, Casadei B . Structure and Function of the Left Atrium and Left Atrial Appendage: AF and Stroke Implications. J Am Coll Cardiol. 2017; 70(25):3157-3172. DOI: 10.1016/j.jacc.2017.10.063. View

Bourier F, Duchateau J, Vlachos K, Lam A, Martin C, Takigawa M . High-power short-duration versus standard radiofrequency ablation: Insights on lesion metrics. J Cardiovasc Electrophysiol. 2018; 29(11):1570-1575. DOI: 10.1111/jce.13724. View

Ravi V, Poudyal A, Abid Q, Larsen T, Krishnan K, Sharma P . High-power short duration vs. conventional radiofrequency ablation of atrial fibrillation: a systematic review and meta-analysis. Europace. 2021; 23(5):710-721. DOI: 10.1093/europace/euaa327. View

Aizer A, Qiu J, Cheng A, Wu P, Barbhaiya C, Jankelson L . Rapid pacing and high-frequency jet ventilation additively improve catheter stability during atrial fibrillation ablation. J Cardiovasc Electrophysiol. 2020; 31(7):1678-1686. DOI: 10.1111/jce.14507. View

Pathan F, DElia N, Nolan M, Marwick T, Negishi K . Normal Ranges of Left Atrial Strain by Speckle-Tracking Echocardiography: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr. 2017; 30(1):59-70.e8. DOI: 10.1016/j.echo.2016.09.007. View

Kusa S, Hachiya H, Sato Y, Hara S, Ohya H, Miwa N . Superior vena cava isolation with 50 W high power, short duration ablation strategy. J Cardiovasc Electrophysiol. 2021; 32(6):1602-1609. DOI: 10.1111/jce.15060. View

Ikeda A, Nakagawa H, Lambert H, Shah D, Fonck E, Yulzari A . Relationship between catheter contact force and radiofrequency lesion size and incidence of steam pop in the beating canine heart: electrogram amplitude, impedance, and electrode temperature are poor predictors of electrode-tissue contact force and.... Circ Arrhythm Electrophysiol. 2014; 7(6):1174-80. DOI: 10.1161/CIRCEP.113.001094. View

Takigawa M, Kitamura T, Martin C, Fuimaono K, Datta K, Joshi H . Temperature- and flow-controlled ablation/very-high-power short-duration ablation vs conventional power-controlled ablation: Comparison of focal and linear lesion characteristics. Heart Rhythm. 2020; 18(4):553-561. DOI: 10.1016/j.hrthm.2020.10.021. View

Vassallo F, Cunha C, Serpa E, Meigre L, Carloni H, Simoes Jr A . Comparison of high-power short-duration (HPSD) ablation of atrial fibrillation using a contact force-sensing catheter and conventional technique: Initial results. J Cardiovasc Electrophysiol. 2019; 30(10):1877-1883. DOI: 10.1111/jce.14110. View

10.

Smiseth O, Inoue K . The left atrium: a mirror of ventricular systolic and diastolic function. Eur Heart J Cardiovasc Imaging. 2019; 21(3):270-272. DOI: 10.1093/ehjci/jez305. View

11.

Martin C, Martin R, Gajendragadkar P, Maury P, Takigawa M, Cheniti G . First clinical use of novel ablation catheter incorporating local impedance data. J Cardiovasc Electrophysiol. 2018; 29(9):1197-1206. DOI: 10.1111/jce.13654. View

12.

Ullah W, Hunter R, Baker V, Dhinoja M, Sporton S, Earley M . Factors affecting catheter contact in the human left atrium and their impact on ablation efficacy. J Cardiovasc Electrophysiol. 2014; 26(2):129-36. DOI: 10.1111/jce.12542. View

13.

Todaro M, Choudhuri I, Belohlavek M, Jahangir A, Carerj S, Oreto L . New echocardiographic techniques for evaluation of left atrial mechanics. Eur Heart J Cardiovasc Imaging. 2012; 13(12):973-84. PMC: 3598416. DOI: 10.1093/ehjci/jes174. View

14.

Wakamatsu Y, Nagashima K, Kurokawa S, Otsuka N, Hayashida S, Yagyu S . Impact of the combined use of intracardiac ultrasound and a steerable sheath visualized by a 3D mapping system on pulmonary vein isolation. Pacing Clin Electrophysiol. 2021; 44(4):693-702. DOI: 10.1111/pace.14194. View

15.

Sparks P, Jayaprakash S, Mond H, Vohra J, Grigg L, Kalman J . Left atrial mechanical function after brief duration atrial fibrillation. J Am Coll Cardiol. 1999; 33(2):342-9. DOI: 10.1016/s0735-1097(98)00585-3. View

16.

Ouyang F, Bansch D, Ernst S, Schaumann A, Hachiya H, Chen M . Complete isolation of left atrium surrounding the pulmonary veins: new insights from the double-Lasso technique in paroxysmal atrial fibrillation. Circulation. 2004; 110(15):2090-6. DOI: 10.1161/01.CIR.0000144459.37455.EE. View

17.

Inaba O, Nagata Y, Sekigawa M, Miwa N, Yamaguchi J, Miyamoto T . Impact of impedance decrease during radiofrequency current application for atrial fibrillation ablation on myocardial lesion and gap formation. J Arrhythm. 2018; 34(3):247-253. PMC: 6009992. DOI: 10.1002/joa3.12056. View

18.

Patel A, Fatemi O, Norton P, West J, Helms A, Kramer C . Cardiac cycle-dependent left atrial dynamics: implications for catheter ablation of atrial fibrillation. Heart Rhythm. 2008; 5(6):787-93. PMC: 2527027. DOI: 10.1016/j.hrthm.2008.03.003. View

19.

Das M, Loveday J, Wynn G, Gomes S, Saeed Y, Bonnett L . Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. Europace. 2016; 19(5):775-783. DOI: 10.1093/europace/euw105. View

20.

Cieslinski A, Hui W, Oldershaw P, GREGORATOS G, Gibson D . Interaction between systolic and diastolic time intervals in atrial fibrillation. Br Heart J. 1984; 51(4):431-7. PMC: 481526. DOI: 10.1136/hrt.51.4.431. View