Bismpos Dimitrios, Wintrich Jan, Pavlicek Valerie, Spittler Raphael, Benz Alexander P, Böhm Michael, Ferro German Fernandez, Mahfoud Felix, Rostock Thomas, Ukena Christian
Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland University Homburg Saar Germany.
Department of Cardiology/Angiology, Marien Hospital Herne Ruhr University Herne Germany.
J Arrhythm. 2025 May 6;41(3):e70076. doi: 10.1002/joa3.70076. eCollection 2025 Jun.
Very high-power short-duration (vHPSD) ablation with the novel QDOT™ catheter allows the regulation of target temperature by automatically adjusting flow and power during a 4 s application of 90 W. However, the optimal contact force for sufficient lesion creation is unknown.
We enrolled 73 patients with symptomatic atrial fibrillation undergoing pulmonary vein isolation (PVI) using the QDOT catheter in the vHPSD mode (90 W, 4 s). Ablation metrics associated with suboptimal applications, defined as either an impedance drop of ≤5% or a cumulative temperature-limited energy ≤330 J, were collected and analyzed.
A total of 3881 vHPSD applications (53.2 applications per patient) with a mean contact force (CF) of 12.8 ± 6.6 g were analyzed. Significant CF variability and intermittent loss of contact were documented in 18.2% and 8.8% of the applications, respectively. A ΔImp ≤ 5% occurred in 3.9% of vHPSD applications, while a cumulative energy ≤ 330 J was observed in 3% of the applications. Applications with a mean CF < 6 g and >22 g were associated with an inadequate impedance drop (10.3%, Phi coefficient 0.118, < .001) and total applied energy (7.8%, Phi coefficient 0.094, < .001) respectively. At superior PV segments with thick atrial walls, significantly more applications with cumulative energy ≤330 J (4.2% vs. 2.5%; = .007) were observed, especially when mean CF > 18 g was applied (8.4%, Phi coefficient 0.093, = .003).
A lower but also a higher mean contact-force was associated with suboptimal vHPSD applications. Hence, a "16-gram window" of contact-force, from 6 to 22 g, could optimize energy application in vHPSD ablation.
采用新型QDOT™导管进行的超高功率短持续时间（vHPSD）消融可在90瓦4秒的应用过程中通过自动调节流量和功率来调节目标温度。然而，产生足够损伤的最佳接触力尚不清楚。
我们纳入了73例有症状的心房颤动患者，他们使用QDOT导管以vHPSD模式（90瓦，4秒）进行肺静脉隔离（PVI）。收集并分析与次优应用相关的消融指标，次优应用定义为阻抗下降≤5%或累积温度限制能量≤330焦耳。
共分析了3881次vHPSD应用（每位患者53.2次应用），平均接触力（CF）为12.8±6.6克。分别有18.2%和8.8%的应用记录到显著的CF变异性和间歇性接触丧失。3.9%的vHPSD应用中出现ΔImp≤5%，而3%的应用中观察到累积能量≤330焦耳。平均CF<6克和>22克的应用分别与阻抗下降不足（10.3%，Phi系数0.118，<0.001）和总应用能量（7.8%，Phi系数0.094，<0.001）相关。在心房壁较厚的肺静脉上段，观察到累积能量≤330焦耳的应用明显更多（4.2%对2.5%；=0.007），尤其是当平均CF>18克时（8.4%，Phi系数0.093，=0.003）。
较低和较高的平均接触力均与次优的vHPSD应用相关。因此，6至22克的接触力“16克窗口”可优化vHPSD消融中的能量应用。
