Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan;36(1):111-123.
doi: 10.1111/jce.16453. Epub 2024 Nov 6.

Significance of the local largest bipolar voltage for the optimized ablation strategy using very high-power short duration mode

Masateru Takigawa  1 , Shinsuke Miyazaki  1 , Tasuku Yamamoto  1 , Claire A Martin  2   3 , Sayumi Nozaki  1 , Junji Yamaguchi  1 , Iwanari Kawamura  1 , Takashi Ikenouchi  1 , Miho Negishi  1 , Kentaro Goto  1 , Takatoshi Shigeta  1 , Takuro Nishimura  1 , Tomomasa Takamiya  1 , Susumu Tao  1 , Masahiko Goya  1 , Tetsuo Sasano  1
Affiliations

Significance of the local largest bipolar voltage for the optimized ablation strategy using very high-power short duration mode

Masateru Takigawa et al. J Cardiovasc Electrophysiol. 2025 Jan.

Abstract

Purpose: Very high-power short-duration (vHPSD) ablation creates shallower lesions, potentially reducing efficacy. This study aims to identify factors leading to insufficient lesions during pulmonary vein antral isolation (PVAI) with vHPSD-ablation and to develop an optimized PVAI strategy using this technology.

Methods: PVAI was performed on 41 atrial fibrillation patients using vHPSD-ablation (90 W/4 s). Lesion parameters were recorded and analyzed to identify predictors of insufficient lesions. An optimized PVAI strategy, based on these predictors, was tested in subsequent 42 patients.

Results: In total, 3099 RF-applications, including 103(3.3%) insufficient lesions, were analyzed. First-pass PVAI was achieved in 19/40(47.5%) right PVs and 24/41(58.5%) left PVs. Multivariate analysis identified significant predictors of insufficient lesions: local largest bipolar voltage (Bi-V), average contact force, baseline impedance, impedance drop, temperature rise, inter-lesion distance (ILD), and anatomical location (carina or not). An ILD:4-6 mm increased the risk of insufficient lesions 2.2-fold, and lesions at the carina increased it 3.6-fold for both ILD < 4 mm and ILD:4-6 mm. Local largest Bi-V was the strongest predictor for insufficient lesions. The optimized PVAI approach, utilizing vHPSD-ablation with an ILD < 4 mm in non-carinal areas with Bi-V < 4 mV, and high-power ablation-index guided ablation (HPAI, 50 W, ablation-index:450-550) in remaining areas, achieved first-pass PVAI in 92.7% of right PVs and 88.1% of left PVs, using vHPSD-ablation in approximately 65% of total RF-applications. The optimized PVAI achieved significantly higher first-pass PVI rate (p < .0001) with shorter ablation time (p = .04).

Conclusion: Appropriate use of vHPSD and HPAI, based on local largest Bi-V and anatomical information, may achieve high first-pass PVAI rates in shorter ablation time with minimal energy delivery.

Keywords: ablation; atrial fibrillation; high‐power short‐duration; local bipolar voltage; pulmonary vein isolation; temperature control; very high‐power short duration.

PubMed Disclaimer

References

REFERENCES

    1. Seidl S, Mülleder T, Kaiblinger J, et al. Very High‐Power Short‐Duration (HPSD) ablation for pulmonary vein isolation: short and long‐term outcome data. J Cardiovasc Dev Dis. 2022;9:278.
    1. Ravi V, Poudyal A, Abid QUA, et al. High‐power short duration vs. conventional radiofrequency ablation of atrial fibrillation: a systematic review and meta‐analysis. EP Europace. 2021;23:710–721.
    1. Winkle RA. HPSD ablation for AF high‐power short‐duration RF ablation for atrial fibrillation: a review. J Cardiovasc Electrophysiol. 2021;32:2813–2823.
    1. Bortone A, Albenque JP, Ramirez FD, et al. 90 vs 50‐Watt radiofrequency applications for pulmonary vein isolation: experimental and clinical findings. Cir Arrhythm Electrophysiol. 2022;15:E010663.
    1. Reddy VY, Grimaldi M, De Potter T, et al. Pulmonary vein isolation with very High Power, short duration, temperature‐controlled lesions. JACC: Clin Electrophysiol. 2019;5:778–786.