Systematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model

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 les...

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Autores principales:	Argyrios Petras, Zoraida Moreno Weidmann, Massimiliano Leoni, Luca Gerardo-Giorda, Jose M. Guerra
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	radiofrequency ablation high-power short-duration computational modeling lesion science ablation catheter Medical technology R855-855.5
Acceso en línea:	https://doaj.org/article/a33a336ee54048d2aef562497a16fcae
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spelling	oai:doaj.org-article:a33a336ee54048d2aef562497a16fcae2021-11-12T05:15:32ZSystematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model2673-312910.3389/fmedt.2021.747609https://doaj.org/article/a33a336ee54048d2aef562497a16fcae2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmedt.2021.747609/fullhttps://doaj.org/toc/2673-3129Background: 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.Argyrios PetrasZoraida Moreno WeidmannMassimiliano LeoniLuca Gerardo-GiordaLuca Gerardo-GiordaJose M. GuerraFrontiers Media S.A.articleradiofrequency ablationhigh-power short-durationcomputational modelinglesion scienceablation catheterMedical technologyR855-855.5ENFrontiers in Medical Technology, Vol 3 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	radiofrequency ablation high-power short-duration computational modeling lesion science ablation catheter Medical technology R855-855.5
spellingShingle	radiofrequency ablation high-power short-duration computational modeling lesion science ablation catheter Medical technology R855-855.5 Argyrios Petras Zoraida Moreno Weidmann Massimiliano Leoni Luca Gerardo-Giorda Luca Gerardo-Giorda Jose M. Guerra Systematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model
description	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.
format	article
author	Argyrios Petras Zoraida Moreno Weidmann Massimiliano Leoni Luca Gerardo-Giorda Luca Gerardo-Giorda Jose M. Guerra
author_facet	Argyrios Petras Zoraida Moreno Weidmann Massimiliano Leoni Luca Gerardo-Giorda Luca Gerardo-Giorda Jose M. Guerra
author_sort	Argyrios Petras
title	Systematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model
title_short	Systematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model
title_full	Systematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model
title_fullStr	Systematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model
title_full_unstemmed	Systematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model
title_sort	systematic characterization of high-power short-duration ablation: insight from an advanced virtual model
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/a33a336ee54048d2aef562497a16fcae
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Systematic Characterization of High-Power Short-Duration Ablation: Insight From an Advanced Virtual Model

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