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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

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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.

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Author notes

  1. M. Kottmaier and E. Klupp contributed equally to the manuscript

Authors and Affiliations

  1. Department of Electrophysiology, German Heart Center Munich, Technische Universitaet Munich, Lazarettstr. 36, 80636, Munich, Germany

    M. Kottmaier, L. Förschner, N. Harfoush, F. Bourier, S. Mayr, T. Reents, H. Krafft, S. Lengauer, S. Maurer, M. Telishevska, M. Popa, C. Lennerz, G. Hessling & I. Deisenhofer

  2. Deparment of Neuroradiology, Klinikum Rechts Der Isar München, Technische Universitaet Munich, Munich, Germany

    E. Klupp & C. Zimmer

  3. Deparment of Radiology and Nuclear Medicine, German Heart Center Munich, Technische Universitaet Munich, Munich, Germany

    M. Hadamitzki & E. Hendrick

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  1. M. Kottmaier
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Corresponding author

Correspondence to M. Kottmaier.

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Ethical approval was received from our institution. All patients gave written informed consent.

Conflict of interest

M. Kottmaier received travel grants and speakers honorary from Abbott, Biosense Webster and Boston Scientific.

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Kottmaier, M., Förschner, L., Harfoush, N. et al. 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. J Interv Card Electrophysiol 65, 491–497 (2022). https://doi.org/10.1007/s10840-022-01146-8

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