Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Cardiac Arrhythmia Research Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
J Cardiovasc Electrophysiol. 2018 Sep;29(9):1287-1296. doi: 10.1111/jce.13651. Epub 2018 Jun 20.
PV reconnection is often the result of catheter instability and tissue edema. High-power short-duration (HP-SD) ablation strategies have been shown to improve atrial linear continuity in acute pre-clinical models. This study compares the safety, efficacy, and long-term durability of HP-SD ablation with conventional ablation.
In 6 swine, 2 ablation lines were performed anterior and posterior to the crista terminalis, in the smooth and trabeculated right atrium, respectively; and the right superior PV was isolated. In 3 swine, ablation was performed using conventional parameters (Thermocool-Smarttouch SF; 30 W/30 seconds) and in 3 other swine using HP-SD parameters (QDOT-MICRO™, 90 W/4 seconds). After 30 days, linear integrity was examined by voltage mapping and pacing, and the heart and surrounding tissues were examined by histopathology. Acute line integrity was achieved with both ablation strategies; however, HP-SD ablation required 80% less RF time compared with conventional ablation (P ≤ 0.01 for all lines). Chronic line integrity was higher with HP-SD ablation: all 3 posterior lines were continuous and transmural compared to only 1 line created by conventional ablation. In the trabeculated tissue, HP-SD ablation lesions were wider and of similar depth with 1 of 3 lines being continuous compared to 0 of 3 using conventional ablation. Chronic PVI without stenosis was evident in both groups. There were no steam-pops. Pleural markings were present in both strategies, but parenchymal lung injury was only evident with conventional ablation.
HP-SD ablation strategy results in improved linear continuity, shorter ablation time, and a safety profile comparable to conventional ablation.
PV 再连接通常是导管不稳定和组织水肿的结果。高功率短时间（HP-SD）消融策略已被证明可提高急性临床前模型中的心房线性连续性。本研究比较了 HP-SD 消融与常规消融的安全性、疗效和长期耐久性。
在 6 头猪中，分别在界嵴末端的前后侧、平滑和小梁化的右心房中进行 2 条消融线，同时隔离右上腔静脉。在 3 头猪中，使用常规参数（Thermocool-Smarttouch SF；30 W/30 秒）进行消融，在另外 3 头猪中使用 HP-SD 参数（QDOT-MICRO™，90 W/4 秒）进行消融。30 天后，通过电压映射和起搏检查线性完整性，通过组织病理学检查心脏和周围组织。两种消融策略均实现了急性线完整性；然而，HP-SD 消融与常规消融相比，所需的 RF 时间减少了 80%（所有线均 P ≤ 0.01）。慢性线完整性更高与 HP-SD 消融：与常规消融相比，所有 3 条后线均连续且透壁，而仅有 1 条连续。在小梁化组织中，HP-SD 消融病变更宽，深度相似，3 条线中有 1 条连续，而常规消融则无 1 条连续。两组均无狭窄的慢性 PVI。没有蒸汽弹出。两种策略都有胸膜标记，但只有常规消融才有实质肺损伤。
HP-SD 消融策略可提高线性连续性、缩短消融时间，且安全性与常规消融相当。
