Significance of the local largest bipolar voltage for the optimized ablation strategy using very high-power short duration mode.

Autor: Takigawa M; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Miyazaki S; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Yamamoto T; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Martin CA; Royal Papworth Hospital, Cambridge, CB20AY.; Department of Medicine, University of Cambridge, Cambridge, CB2 0AY., Nozaki S; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Yamaguchi J; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Kawamura I; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Ikenouchi T; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Negishi M; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Goto K; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Shigeta T; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Nishimura T; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Takamiya T; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Tao S; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Goya M; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan., Sasano T; Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, 113-8510, Tokyo, Japan.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2024 Nov 06. Date of Electronic Publication: 2024 Nov 06.
DOI: 10.1111/jce.16453
Abstrakt: Purpose: Very high-power short-duration (vHPSD) ablation creates shallower lesions, potentially reducing efficacy. This study aims to identify factors leading to insufficient lesions during pulmonary vein antral isolation (PVAI) with vHPSD-ablation and to develop an optimized PVAI strategy using this technology.
Methods: PVAI was performed on 41 atrial fibrillation patients using vHPSD-ablation (90 W/4 s). Lesion parameters were recorded and analyzed to identify predictors of insufficient lesions. An optimized PVAI strategy, based on these predictors, was tested in subsequent 42 patients.
Results: In total, 3099 RF-applications, including 103(3.3%) insufficient lesions, were analyzed. First-pass PVAI was achieved in 19/40(47.5%) right PVs and 24/41(58.5%) left PVs. Multivariate analysis identified significant predictors of insufficient lesions: local largest bipolar voltage (Bi-V), average contact force, baseline impedance, impedance drop, temperature rise, inter-lesion distance (ILD), and anatomical location (carina or not). An ILD:4-6 mm increased the risk of insufficient lesions 2.2-fold, and lesions at the carina increased it 3.6-fold for both ILD < 4 mm and ILD:4-6 mm. Local largest Bi-V was the strongest predictor for insufficient lesions. The optimized PVAI approach, utilizing vHPSD-ablation with an ILD < 4 mm in non-carinal areas with Bi-V < 4 mV, and high-power ablation-index guided ablation (HPAI, 50 W, ablation-index:450-550) in remaining areas, achieved first-pass PVAI in 92.7% of right PVs and 88.1% of left PVs, using vHPSD-ablation in approximately 65% of total RF-applications. The optimized PVAI achieved significantly higher first-pass PVI rate (p < .0001) with shorter ablation time (p = .04).
Conclusion: Appropriate use of vHPSD and HPAI, based on local largest Bi-V and anatomical information, may achieve high first-pass PVAI rates in shorter ablation time with minimal energy delivery.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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