In silico analysis of the relation between conventional and high-power short-duration RF ablation settings and resulting lesion metrics.
ablation
contact force
high-power short-duration
lesion
radiofrequency
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
19
11
2019
revised:
06
04
2020
accepted:
09
04
2020
pubmed:
14
4
2020
medline:
13
4
2021
entrez:
14
4
2020
Statut:
ppublish
Résumé
Use of lesion metric indices is a proposed strategy to support pulmonary vein isolation procedures and these indices show good correlations with lesion sizes. The aim of this in silico study is to provide a detailed analysis of radiofrequency (RF) settings, including high-power short-duration (HPSD) settings, and resulting lesion metric indices. A software program was designed which simulated virtual RF ablations. Lesion metric indices (Ablation index: AI, Lesion size index: LSI) were calculated based on underlying RF settings (contact force [CF], power, duration). In series of calculations, the applied settings were varied within defined ranges (CF: 1-80 g, power: 1-60 W, duration: 1-60 seconds). Overall, n = 388 000 virtual ablations were calculated. The resulting lesion metric indices were compared with each other and analyzed in relation to respective RF settings. Increasing contact force from 1 to 10 g resulted in a 4.4-fold LSI value, whilst increasing contact force from 10 to 20g resulted in a 1.5-fold value (P < .01). When RF power was increased by 10 W, lesion metric indices increased between 1.3- and 1.6-fold. A prolongation of RF duration by 10 seconds resulted in a 1.2-to-1.3-fold increase of lesion metric indices. HPSD RF applications of 50 W, 11 to 13 seconds, and 60 W, 8 to 10 seconds resulted in equivalent lesion metric indices when compared with 30 W, 30 seconds conventional ablations. The findings support the clinical use of contact forces within a 10 to 20 g range. AI is more sensitive to RF duration, whereas LSI is more sensitive to contact force. HPSD RF settings can successfully be derived from lesion metric indices.
Sections du résumé
BACKGROUND
Use of lesion metric indices is a proposed strategy to support pulmonary vein isolation procedures and these indices show good correlations with lesion sizes. The aim of this in silico study is to provide a detailed analysis of radiofrequency (RF) settings, including high-power short-duration (HPSD) settings, and resulting lesion metric indices.
METHODS AND RESULTS
A software program was designed which simulated virtual RF ablations. Lesion metric indices (Ablation index: AI, Lesion size index: LSI) were calculated based on underlying RF settings (contact force [CF], power, duration). In series of calculations, the applied settings were varied within defined ranges (CF: 1-80 g, power: 1-60 W, duration: 1-60 seconds). Overall, n = 388 000 virtual ablations were calculated. The resulting lesion metric indices were compared with each other and analyzed in relation to respective RF settings. Increasing contact force from 1 to 10 g resulted in a 4.4-fold LSI value, whilst increasing contact force from 10 to 20g resulted in a 1.5-fold value (P < .01). When RF power was increased by 10 W, lesion metric indices increased between 1.3- and 1.6-fold. A prolongation of RF duration by 10 seconds resulted in a 1.2-to-1.3-fold increase of lesion metric indices. HPSD RF applications of 50 W, 11 to 13 seconds, and 60 W, 8 to 10 seconds resulted in equivalent lesion metric indices when compared with 30 W, 30 seconds conventional ablations.
CONCLUSIONS
The findings support the clinical use of contact forces within a 10 to 20 g range. AI is more sensitive to RF duration, whereas LSI is more sensitive to contact force. HPSD RF settings can successfully be derived from lesion metric indices.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1332-1339Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Neuzil P, Reddy VY, Kautzner J, et al. Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circ Arrhythm Electrophysiol. 2013;6:327-333.
Marijon E, Fazaa S, Narayanan K, et al. Real-time contact force sensing for pulmonary vein isolation in the setting of paroxysmal atrial fibrillation: procedural and 1-year results. J Cardiovasc Electrophysiol. 2014;25:130-137.
Afzal MR, Chatta J, Samanta A, et al. Use of contact force sensing technology during radiofrequency ablation reduces recurrence of atrial fibrillation: a systematic review and meta-analysis. Heart Rhythm. 2015;12:1990-1996.
Das M, Loveday JJ, Wynn GJ, et al. Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. Europace. 2017;19:775-783.
Phlips T, Taghji P, El Haddad M, et al. Improving procedural and one-year outcome after contact force-guided pulmonary vein isolation: the role of interlesion distance, ablation index, and contact force variability in the 'CLOSE'-protocol. Europace. 2018;20(FI_3):f419-f427.
Dhillon G, Ahsan S, Honarbakhsh S, et al. A multicentered evaluation of ablation at higher power guided by ablation index: Establishing ablation targets for pulmonary vein isolation. J Cardiovasc Electrophysiol. 2019;30:357-365.
Hussein A, Das M, Riva S, et al. Use of Ablation Index-guided ablation results in high rates of durable pulmonary vein isolation and freedom from arrhythmia in persistent atrial fibrillation patients. Circ Arrhythm Electrophysiol. 2018;11:e006576.
Nakagawa H, Ideda A, Constantine G, et al. Controlling lesion size and incidence of steam pop by controlling contact force, radio-frequency power and application time (force-power-time index) in canine beating hearts. Heart Rhythm. 2012;9:S5.
Nakagawa H, Ikeda A, Govari A, et al. Prospective study to test the ability to create RF lesions at predicted depths of 3, 5, 7 and 9 mm using formula incorporating contact force, radiofrequency power and application time (force-power-time index) in the beating canine heart. Heart Rhythm. 2013;10:S481-S491.
Calzolari V, De Mattia L, Indiani S, et al. In vitro validation of the lesion size index to predict lesion width and depth after irrigated radiofrequency ablation in a porcine model. JACC: Clinical Electrophysiology. 2017;3:1126-1135.
Kawaji T, Hojo S, Kushiyama A, et al. Limitations of lesion quality estimated by ablation index: an in vitro study. J Cardiovasc Electrophysiol. 2019;30:926-933.
Winkle RA, Mohanty S, Patrawala RA, et al. Low complication rates using high power (45-50 W) for short duration for atrial fibrillation ablations. Heart Rhythm. 2019;16:165-169.
Barkagan M, Contreras-Valdes FM, Leshem E, Buxton AE, Nakagawa H, Anter E. High-power and short-duration ablation for pulmonary vein isolation: safety, efficacy, and long-term durability. J Cardiovasc Electrophysiol. 2018;29:1287-1296.
Bourier F, Duchateau J, Vlachos K, et al. High-power short-duration versus standard radiofrequency ablation: insights on lesion metrics. J Cardiovasc Electrophysiol. 2018;29:1570-1575.
Chen S, Schmidt B, Bordignon S, et al. Ablation index-guided 50 W ablation for pulmonary vein isolation in patients with atrial fibrillation: Procedural data, lesion analysis, and initial results from the FAFA AI High Power Study. J Cardiovasc Electrophysiol. 2019;30:2724-2731.
Barkagan M, Rottmann M, Leshem E, Shen C, Buxton AE, Anter E. Effect of baseline impedance on ablation lesion dimensions. Circ Arrhythm Electrophysiol. 2018;11:e006690.
Bourier F, Gianni C, Dare M, et al. Fiberoptic contact-force sensing electrophysiological catheters: how precise is the technology? J Cardiovasc Electrophysiol. 2017;28:109-114.
Haines DE. Determinants of lesion size during radiofrequency catheter ablation: The role of electrode-tissue contact force and duration of energy delivery. J Cardiovasc Electrophysiol. 1991;2:509-515.
Yokoyama K, Nakagawa H, Shah DC, et al. Novel contact force sensor incorporated in irrigated radifrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circ Arrhythm Electrophysiol. 2008;1:354-362.
Perna F, Heist EK, Danik SB, Barrett CD, Ruskin JN, Mansour M. Assessment of catheter tip contact force resulting in cardiac perforation in swine atria using force sensing technology. Circ Arrhythm Electrophysiol. 2011;4:218-224.
Leshem E, Tschabrunn CM, Contreras-Valdes FM, Zilberman I, Anter E. Evaluation of ablation catheter technology: Comparison between thigh preparation model and an in vivo beating heart. Heart Rhythm. 2017;14:1234-1240.
Aryana A, O'Neill PG, Pujara DK, et al. Impact of irrigation flow rate and intrapericardial fluid on cooled-tip epicardial radiofrequency ablation. Heart Rhythm. 2016;13:1602-1611.
Winterfield JR, Jensen J, Gilbert T, et al. Lesion size and safety comparison between the novel flex tip on the flexability ablation catheter and the solid tips on the ThermoCool and ThermoCool SF ablation catheters. J Cardiovasc Electrophysiol. 2016;27:102-109.
Guerra JM, Jorge E, Raga S, et al. Effects of open-irrigated radiofrequency ablation catheter design on lesion formation and complications: in vitro comparison of 6 different devices. J Cardiovasc Electrophysiol. 2013;24:1157-1162.
Ullah W, Hunter RJ, Finlay MC, et al. Ablation index and surround flow catheter irrigation: impedance-based appraisal in clinical ablation. JACC Clin Electrophysiol. 2017;3:1080-1088.