Systematic Characterization of High-Power Short-Duration Ablation : Insight From an Advanced Virtual Model
Petras, Argyrios (Johann Radon Institute for Computational and Applied Mathematics (RICAM), Austrian Academy of Sciences)
Moreno Weidmann, Zoraida (Institut d'Investigació Biomèdica Sant Pau)
Leoni, Massimiliano (Johann Radon Institute for Computational and Applied Mathematics (RICAM), Austrian Academy of Sciences)
Gerardo-Giorda, Luca (Johannes Kepler University)
Guerra Ramos, José María (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Date:	2021
Abstract:	Background: High-power short-duration (HPSD) recently emerged as a new approach to radiofrequency (RF) catheter ablation. However, basic and clinical data supporting its effectiveness and safety is still scarce. Objective: We aim to characterize HPSD with an advanced virtual model, able to assess lesion dimensions and complications in multiple conditions and compare it to standard protocols. Methods: We evaluate, on both atrium and ventricle, three HPSD protocols (70 W/8 s, 80 W/6 s, and 90 W/4 s) through a realistic 3D computational model of power-controlled RF ablation, varying catheter tip design (spherical/cylindrical), contact force (CF), blood flow, and saline irrigation. Lesions are defined by the 50°C isotherm contour. Ablations are deemed safe or complicated by pop (tissue temperature >97°C) or charring (blood temperature >80°C). We compared HPSD with standards protocols (30-40 W/30 s). We analyzed the effect of a second HPSD application. Results: We simulated 432 applications. Most (79%) associated a complication, especially in the atrium. The three HPSD protocols performed similarly in the atrium, while 90 W/4 s appeared the safest in the ventricle. Low irrigation rate led frequently to charring (72%). High-power short-duration lesions were 40-60% shallower and smaller in volume compared to standards, although featuring similar width. A second HPSD application increased lesions to a size comparable to standards. Conclusion: High-power short-duration lesions are smaller in volume and more superficial than standards but comparable in width, which can be advantageous in the atrium. A second application can produce lesions similar to standards in a shorter time. Despite its narrow safety margin, HPSD seems a valuable new clinical approach.
Grants:	Agencia Estatal de Investigación RTI2018-093416-B-I00
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Radiofrequency ablation ; High-power short-duration ; Computational modeling ; Lesion science ; Ablation catheter
Published in:	Frontiers in Medical Technology, Vol. 3 (november 2021) , ISSN 2673-3129

DOI: 10.3389/fmedt.2021.747609
PMID: 35047958

12 p, 8.0 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
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