Ptaszek Leon M, Koruth Jacob, Santangeli Pasquale, Piccini Jonathan P, Ranjan Ravi, Mahapatra Srijoy, Pipenhagen Catherine, Fish Jeffrey M, Moon L Boyce, Ambrosius Nicholas M, Boudlali Hana, Jensen James A
Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
Heart Rhythm O2. 2022 Oct 25;4(1):42-50. doi: 10.1016/j.hroo.2022.10.009. eCollection 2023 Jan.
High-power, short-duration (HPSD) radiofrequency ablation (RFA) may reduce ablation time. Concerns that catheter-mounted thermocouples (TCs) can underestimate tissue temperature, resulting in elevated risk of steam pop formation, potentially limit widespread adoption of HPSD ablation.
The purpose of this study was to compare the safety and efficacy of HPSD and low-power, long-duration (LPLD) RFA in the context of pulmonary vein isolation (PVI).
An open-irrigated ablation catheter with a contact force sensor and a flexible-tip electrode containing a TC at its distal end (TactiFlex Ablation Catheter, Sensor Enabled, Abbott) was used to isolate the left pulmonary veins (PVs) in 12 canines with HPSD RFA (50 W for 10 seconds) and LPLD RFA (30 W for a maximum of 60 seconds). PVI was assessed at 30 minutes and 28 ± 3 days postablation. Computed tomographic scans were performed to assess PV stenosis after RFA. Lesions were evaluated with histopathology.
A total of 545 ablations were delivered: 252 with LPLD (0 steam pops) and 293 with HPSD RFA (2 steam pops) ( = .501). Ablation time required to achieve PVI was >3-fold shorter for HPSD than for LPLD RFA ( = .001). All 24 PVs were isolated 30 minutes after ablation, with 12/12 LPLD-ablated and 11/12 HPSD-ablated PVs still isolated at follow-up. Histopathology revealed transmural ablations for HPSD and LPLD RFA. No major adverse events occurred.
An investigational ablation catheter effectively delivered RFA lesions. Ablation time required to achieve PVI with HPSD with this catheter was >3-fold shorter than with LPLD RFA.
高功率、短持续时间（HPSD）射频消融（RFA）可能会缩短消融时间。人们担心导管安装的热电偶（TCs）会低估组织温度，从而导致蒸汽泡形成的风险增加，这可能会限制HPSD消融的广泛应用。
本研究的目的是比较HPSD和低功率、长持续时间（LPLD）RFA在肺静脉隔离（PVI）中的安全性和有效性。
使用带有接触力传感器和远端包含TC的柔性尖端电极的开放式灌注消融导管（TactiFlex消融导管，启用传感器，雅培公司），对12只犬进行HPSD RFA（50W，持续10秒）和LPLD RFA（30W，最长持续60秒）以隔离左肺静脉（PVs）。在消融后30分钟和28±3天评估PVI。进行计算机断层扫描以评估RFA后的PV狭窄情况。通过组织病理学评估病变。
共进行了545次消融：252次采用LPLD（无蒸汽泡），293次采用HPSD RFA（2次蒸汽泡）（P = 0.501）。实现PVI所需的消融时间，HPSD比LPLD RFA短3倍以上（P = 0.001）。消融后30分钟所有24条PV均被隔离，随访时，LPLD消融的12条PV中有12条、HPSD消融的12条PV中有11条仍被隔离。组织病理学显示HPSD和LPLD RFA均有透壁消融。未发生重大不良事件。
一种研究性消融导管有效地产生了RFA病变。使用该导管进行HPSD实现PVI所需的消融时间比LPLD RFA短3倍以上。
