Temperature-controlled high-power short-duration ablation with 90?W for 4?s: outcome, safety, biophysical characteristics and cranial MRI findings in patients undergoing pulmonary vein isolation

摘要

Abstract Background High-power short-duration (HPSD) radiofrequency ablation (RFA) is highly efficient and safe while reducing procedure and RF time in pulmonary vein isolation (PVI). The QDot? catheter is a novel contact force ablation catheter that allows automated flow and power adjustments depending on the local tissue temperature to maintain a target temperature during 90?W/4?s lesions. We analysed intraprocedural data and periprocedural safety using the QDot-catheter in patients undergoing PVI for paroxysmal atrial fibrillation (PAF).Methods We included n?=?48 patients undergoing PVI with the QDot-catheter with a temperature-controlled HPSD ablation mode with 90?W/4?s (TC-HPSD). If focal reconnection occurred besides repeat ablation, the ablation mode was changed to 50?W/15?s (QMode). N?=?23 patients underwent cerebral MRI to detect silent cerebral lesions.Results Mean RF time was 8.1?±?2.8?min, and procedure duration was 84.5?±?30?min. The overall maximal measured catheter tip temperature was 52.0?°C?±?4.6?°C, mean overall applied current was 871?mA?±?44?mA and overall applied energy was 316?J?±?47?J. The mean local impedance drop was 12.1?±?2.4 Ohms. During adenosine challenge, n?=?14 (29%) patients showed dormant conduction. A total of n?=?24 steam pops were detected in n?=?18 patients (39.1%), while no pericardial tamponade occurred. No periprocedural thromboembolic complications occurred, while n?=?4 patients (17.4%) showed silent cerebral lesion.Conclusions TC-HPSD ablation with 90?W/4?s using the QDot-catheter led to a reduction of procedure and RF time, while no major complications occurred. Despite optimized temperature control and power adjustment, steam pops occurred in a rather high number of patients, while none of them leads to tamponade or to clinical or neurological deficits.