Abstract 776 Analysis of standard and high-power short-duration RF ablation settings and resulting AI and LSI values

Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Analysis of standard and high-power short-duration RF ablation settings and resulting AI and LSI values
F. Bourier¹, M. Kottmaier², M.-A. Popa², E. Risse², S. Lengauer¹, H. Krafft², F. Bahlke¹, M. Telishevska¹, T. Reents², G. Heßling¹, I. Deisenhofer¹
¹Abteilung für Elektrophysiologie, Deutsches Herzzentrum München, München; ²Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München;
Background Lesion metric indices (Ablation index: AI, Lesion size index: LSI) 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. Methods An in-silico model for virtual ablation processes was designed. AI and LSI values were calculated based on underlying RF settings (CF, power, duration), which were systematically varied within defined ranges (CF: 1g-80g, power: 1W-60W, duration: 1s-60s). The resulting lesion metric indices were compared to each other and analyzed in relation to respective RF settings. Results Overall, 388,000 virtual ablations were simulated. Increasing contact force from 1g to 10g resulted in a significantly higher increase of lesion metric indices (LSI: +338%, AI: +73%) when compared to an increase from 10g to 20g (LSI: +51%, AI: +18%), p<0.01. A further increase of contact force from 20g to 30g (LSI: +19%, AI: +10%) or 30g to 40g (LSI: +10%, AI: +7%) resulted in significantly smaller increases in lesion metric indices, p<0.01. Increasing RF power from 20W to 30W resulted in a significantly higher increase in lesion metric indices (LSI: +29%, AI: +26%) when compared to a 30W to 40W (LSI: +15%, AI: +18%) or 40W to 50W (LSI: +9%, AI: +13%) RF power increase, p<0.01. 50W, 13±0.3s (AI based) and 50W, 11.0±0.3 (LSI based) as well as 60W, 9.8±0.2 (AI based) and 60W, 8.3±0.1 (LSI based) HPSD RF settings were identified, which result in the same lesion metric indices (AI: 477, LSI: 3.4) as 30W, 30s ablations (Figure). Conclusions AI was shown to be more sensitive to RF duration, whereas LSI was shown to be more sensitive to contact force. In both AI and LSI lesion metrics, RF power showed similar effects on lesion size. High-power short-duration RF settings of 50W, 11s-13s and 60W, 8s-10s resulted in equivalent lesion metric indices when compared to 30W, 30s conventional ablations.
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