TY - JOUR
T1 - Recovery of Conduction Following High-Power Short-Duration Ablation in Patients With Atrial Fibrillation
T2 - A Single-Center Experience
AU - Mohanty, Sanghamitra
AU - Trivedi, Chintan
AU - Della Rocca, Domenico G.
AU - Gianni, Carola
AU - MacDonald, Bryan
AU - Quintero Mayedo, Angel
AU - Al-Ahmad, Amin
AU - Burkhardt, John D.
AU - Bassiouny, Mohamed
AU - Gallinghouse, G. Joseph
AU - Horton, Rodney
AU - Di Biase, Luigi
AU - Natale, Andrea
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - Background: Optimal duration of energy delivery in high-power short-duration (HPSD) ablation to create a durable lesion in atrial fibrillation (AF) is not clear yet. We evaluated the association of electrical reconnection with lesion duration in HPSD-ablation. Methods: HPSD ablation was defined as maximum temperature at 42 °C and power delivery at 45 W for 10 to 15 seconds (5 seconds in coronary sinus [CS] and left atrial posterior wall [LAPW] near the esophagus). In some patients, a mechanical tool was used to deflect the esophagus away from the ablation site. Results: Consecutive 1749 patients with AF (left atrial appendage and CS isolation: 1451) receiving redo ablation after a prior HPSD procedure were included. At the HPSD ablation, mean duration of lesion was significantly shorter in the LAPW facing esophagus compared with elsewhere (5.2±1.5 versus 12.5±1.7 seconds, P<0.001). Application duration was reduced to <10 seconds in 1221 (84%) patients receiving left atrial appendage and CS isolation. At the redo, recovery of conduction was noted in the CS (592, 40.8%), left atrial appendage (493, 34%), and PV and LAPW (249, 14.2%). Of the 249 patients with LAPW reconnection, 91% (n=227) had the conduction recovered in the area facing the esophagus. In 73 patients, esophageal displacement device was used during the HPSD ablation. Average duration of lesions in LAPW among those 73 patients was 9.2±2 seconds. PV-LAPW reconnection was observed in 3/73 (4.1%) patients. Conclusions: HPSD ablation with lesion duration of <10 seconds was associated with conduction recovery in the left atrial appendage, CS, and the LAPW area facing esophagus.
AB - Background: Optimal duration of energy delivery in high-power short-duration (HPSD) ablation to create a durable lesion in atrial fibrillation (AF) is not clear yet. We evaluated the association of electrical reconnection with lesion duration in HPSD-ablation. Methods: HPSD ablation was defined as maximum temperature at 42 °C and power delivery at 45 W for 10 to 15 seconds (5 seconds in coronary sinus [CS] and left atrial posterior wall [LAPW] near the esophagus). In some patients, a mechanical tool was used to deflect the esophagus away from the ablation site. Results: Consecutive 1749 patients with AF (left atrial appendage and CS isolation: 1451) receiving redo ablation after a prior HPSD procedure were included. At the HPSD ablation, mean duration of lesion was significantly shorter in the LAPW facing esophagus compared with elsewhere (5.2±1.5 versus 12.5±1.7 seconds, P<0.001). Application duration was reduced to <10 seconds in 1221 (84%) patients receiving left atrial appendage and CS isolation. At the redo, recovery of conduction was noted in the CS (592, 40.8%), left atrial appendage (493, 34%), and PV and LAPW (249, 14.2%). Of the 249 patients with LAPW reconnection, 91% (n=227) had the conduction recovered in the area facing the esophagus. In 73 patients, esophageal displacement device was used during the HPSD ablation. Average duration of lesions in LAPW among those 73 patients was 9.2±2 seconds. PV-LAPW reconnection was observed in 3/73 (4.1%) patients. Conclusions: HPSD ablation with lesion duration of <10 seconds was associated with conduction recovery in the left atrial appendage, CS, and the LAPW area facing esophagus.
KW - atrial fibrillation
KW - catheter ablation
KW - coronary sinus
KW - left atrial appendage
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U2 - 10.1161/CIRCEP.121.010096
DO - 10.1161/CIRCEP.121.010096
M3 - Article
C2 - 34583523
AN - SCOPUS:85119458041
SN - 1941-3149
VL - 14
SP - E010096
JO - Circulation: Arrhythmia and Electrophysiology
JF - Circulation: Arrhythmia and Electrophysiology
IS - 10
ER -