Longer Duration Versus Increasing Power During Radiofrequency Ablation Yields Different Ablation Lesion Characteristics


OBJECTIVES: The goal of this study was to characterize differences in ablation lesions with varying radiofrequency ablation (RFA) power and time.

BACKGROUND: Increasing power delivery or prolonging duration can improve the efficacy of RFA. However, the extent to which ablation lesion characteristics change, based on varying degrees of power and duration, is unknown.

METHODS: An ex vivo model consisting of viable bovine myocardium in a circulating warmed saline bath was used. An open irrigated RFA catheter was positioned with 10 g of force in the perpendicular position, and RFA was delivered at powers of 20, 30, 40, and 50 W and for various time intervals, up to a total of 90 s, at each power. An in vivo porcine thigh preparation model was used to perform RFA at 50 W for 5 s and 20 W for 30 s. Lesion volumes were analyzed.

RESULTS: Greater power delivery and longer radiofrequency time increased ablation lesion size. However, compared with a proportional change in radiofrequency duration, the same proportional increase in power produced a significantly larger lesion volume (p < 0.01). For in vivo models, 50 W/5 s ablation lesions yielded similar volumes but significantly less depth than 20 W/30 s ablation lesions. Peak temperatures were not significantly different at 2 and 4 mm with 50 W/5 s versus 20 W/30 s.

CONCLUSION: Varying power and duration will confer different ablation lesion characteristics that can be tailored according to the substrate/anatomy that is being ablated. This phenomenon has important implications during catheter ablation.

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Borne RT, Sauer WH, Zipse MM, et al. JACC Clin Electrophysiol 2018;4:902–8.