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Low complication rates using high power (45-50 W) for short duration for atrial fibrillation ablations.
- Source :
-
Heart rhythm [Heart Rhythm] 2019 Feb; Vol. 16 (2), pp. 165-169. - Publication Year :
- 2019
-
Abstract
- Background: Many centers use radiofrequency (RF) energy at 25-35 W for 30-60 seconds. There is a safety concern about using higher power, especially on the posterior wall.<br />Objective: The purpose of this study was to examine complication rates for atrial fibrillation (AF) ablations performed with high-power, short-duration RF energy.<br />Methods: We examined the complication rates of 4 experienced centers performing AF ablations at RF powers from 45-50 W for 2-15 seconds per lesion. In total, 13,974 ablations were performed in 10,284 patients. On the posterior wall, 11,436 ablations used 45-50 W for 2-10 seconds, and 2538 ablations used power reduced to 35 W for 20 seconds. Esophageal temperature monitoring was used in 13,858 (99.2%).<br />Results: Demographics were age 64 ± 11 years, male 68%, left atrial size 4.4 ± 0.7 cm, paroxysmal AF 37%, persistent AF 42%, longstanding AF 20%, antiarrhythmic drugs failed 1.4 ± 0.7, hypertension 54%, diabetes 15%, previous cerebrovascular accident/transient ischemic attack 7%, and CHA <subscript>2</subscript> DS <subscript>2</subscript> -VASc score 2.1 ± 1.4. Procedural time was 116 ± 41 minutes. Complications were death in 2 (0.014%; 1 due to stroke and 1 due to atrioesophageal fistula), pericardial tamponade in 33 (0.24%; 26 tapped, 7 surgical), strokes <48 hours in 6 (0.043%), strokes 48 hours-30 days in 6 (0.043%), pulmonary vein stenosis requiring intervention in 2 (0.014%), phrenic nerve paralysis in 2 (0.014%; both resolved), steam pops 2 (0.014%) without complications, and catheter char 0 (0.00%). There was 1 atrioesophageal fistula in 11,436 ablations using power 45-50 W on the posterior wall and 3 in 2538 ablated with 35 W on the posterior wall (P = .021), although 2 of the 3 had no esophageal monitoring during a fluoroless procedure.<br />Conclusion: AF ablations can be performed at 45-50 W for short durations with very low complication rates. High-power, short-duration ablations have the potential to shorten procedural and total RF times and create more localized and durable lesions.<br /> (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Burns, Electric etiology
Burns, Electric prevention & control
Female
Humans
Male
Middle Aged
Outcome and Process Assessment, Health Care
Pulmonary Veins surgery
Time Factors
Atrial Fibrillation surgery
Catheter Ablation adverse effects
Catheter Ablation methods
Intraoperative Complications etiology
Intraoperative Complications prevention & control
Postoperative Complications diagnosis
Postoperative Complications etiology
Postoperative Complications prevention & control
Radio Waves adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1556-3871
- Volume :
- 16
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Heart rhythm
- Publication Type :
- Academic Journal
- Accession number :
- 30712645
- Full Text :
- https://doi.org/10.1016/j.hrthm.2018.11.031