In silico analysis of the relation between conventional and high-power short-duration RF ablation settings and resulting lesion metrics.

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. © 2020 Wiley Periodicals, Inc.

Citation

Felix Bourier, Konstantinos Vlachos, Antonio Frontera, Claire A Martin, Anna Lam, Masateru Takigawa, Takeshi Kitamura, Ghassen Cheniti, Josselin Duchateau, Thomas Pambrun, Nicolas Derval, Arnaud Denis, Hubert Cochet, Mélèze Hocini, Frédéric Sacher, Michel Haïssaguerre, Pierre Jaïs. In silico analysis of the relation between conventional and high-power short-duration RF ablation settings and resulting lesion metrics. Journal of cardiovascular electrophysiology. 2020 Jun;31(6):1332-1339

Mesh Tags

PMID: 32282970

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