Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Medical Research Support Center, Institute of Medical Science, Section of Laboratory for Animal Experiments, Nihon University School of Medicine, Tokyo, Japan.
J Cardiovasc Electrophysiol. 2024 Jan;35(1):7-15. doi: 10.1111/jce.16092. Epub 2023 Oct 5.
High-power short-duration (HPSD) ablation at 50 W, guided by ablation index (AI) or lesion size index (LSI), and a 90 W/4 s very HSPD (vHPSD) setting are available for atrial fibrillation (AF) treatment. Yet, tissue temperatures during ablation with different catheters around venoatrial junction and collateral tissues remain unclear.
In this porcine study, we surgically implanted thermocouples on the epicardium near the superior vena cava (SVC), right pulmonary vein, and esophagus close to the inferior vena cava. We then compared tissue temperatures during 50W-HPSD guided by AI 400 or LSI 5.0, and 90 W/4 s-vHPSD ablation using THERMOCOOL SMARTTOUCH SF (STSF), TactiCath ablation catheter, sensor enabled (TacthCath), and QDOT MICRO (Qmode and Qmode+ settings) catheters.
STSF produced the highest maximum tissue temperature (T ), followed by TactiCath, and QDOT MICRO in Qmode and Qmode+ (62.7 ± 12.5°C, 58.0 ± 10.1°C, 50.0 ± 12.1°C, and 49.2 ± 8.4°C, respectively; p = .005), achieving effective transmural lesions. Time to lethal tissue temperature ≥50°C (t-T ≥ 50°C) was fastest in Qmode+, followed by TacthCath, STSF, and Qmode (4.3 ± 2.5, 6.4 ± 1.9, 7.1 ± 2.8, and 7.7 ± 3.1 s, respectively; p < .001). The catheter tip-to-thermocouple distance for lethal temperature (indicating lesion depth) from receiver operating characteristic curve analysis was deepest in STSF at 5.2 mm, followed by Qmode at 4.3 mm, Qmode+ at 3.1 mm, and TactiCath at 2.8 mm. Ablation at the SVC near the phrenic nerve led to sudden injury at t-T ≥ 50°C in all four settings. The esophageal adventitia injury was least deep with Qmode+ ablation (0.4 ± 0.1 vs. 0.8 ± 0.4 mm for Qmode, 0.9 ± 0.3 mm for TactiCath, and 1.1 ± 0.5 mm for STSF, respectively; p = .005), correlating with T .
This study revealed distinct tissue temperature patterns during HSPD and vHPSD ablations with the three catheters, affecting lesion effectiveness and collateral damage based on T and/or t-T ≥ 50°C. These findings provide key insights into the safety and efficacy of AF ablation with these four settings.
高功率短时间（HPSD）消融在 50W 时，可通过消融指数（AI）或病变大小指数（LSI）指导，以及 90W/4s 的超高 HSPD（vHPSD）设置用于治疗心房颤动（AF）。然而，围绕腔静脉和侧支组织的不同导管消融时的组织温度仍不清楚。
在这项猪研究中，我们在心脏外科手术中在靠近上腔静脉（SVC）的心脏外膜、右肺静脉和靠近下腔静脉的食管上植入热电偶。然后，我们比较了 50W-HPSD 消融时使用 THERMOCOOL SMARTTOUCH SF（STSF）、TactiCath 消融导管、带传感器的 TactiCath（TacthCath）和 QDOT MICRO（Qmode 和 Qmode+ 设置）导管时的组织温度。
STSF 产生的最高组织温度（T）最高，其次是 TactiCath 和 QDOT MICRO 在 Qmode 和 Qmode+（分别为 62.7±12.5°C、58.0±10.1°C、50.0±12.1°C 和 49.2±8.4°C；p=0.005），实现有效的透壁性病变。达到致死性组织温度≥50°C（t-T≥50°C）的时间最快的是 Qmode+，其次是 TacthCath、STSF 和 Qmode（分别为 4.3±2.5、6.4±1.9、7.1±2.8 和 7.7±3.1s；p<0.001）。从接收者操作特征曲线分析的致死温度（指示病变深度）的导管尖端-热电偶距离在 STSF 最深，为 5.2mm，其次是 Qmode 为 4.3mm，Qmode+为 3.1mm，TactiCath 为 2.8mm。SVC 附近靠近膈神经的消融会导致在所有四种设置下达到 t-T≥50°C 时突然损伤。在 Qmode+消融时，食管外膜损伤最小（0.4±0.1mm 比 Qmode 为 0.8±0.4mm，TactiCath 为 0.9±0.3mm，STSF 为 1.1±0.5mm；p=0.005），与 T 相关。
这项研究揭示了三种导管在 HSPD 和 vHPSD 消融时的不同组织温度模式，基于 T 和/或 t-T≥50°C 影响病变效果和侧支损伤。这些发现为这四种设置下的 AF 消融的安全性和有效性提供了关键见解。
