Optimal interlesion distance for 90 and 50 watt radiofrequency applications with low ablation index values: experimental findings in a chronic ovine model

Abstract Aims The optimal interlesion distance (ILD) for 90 and 50 W radiofrequency applications with low ablation index (AI) values in the atria has not been established. Excessive ILDs can predispose to interlesion gaps, whereas restrictive ILDs can predispose to procedural complications. The pres...

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Bibliographic Details
Published in:	Europace (London, England) Vol. 25; no. 11
Main Authors:	Bortone, Agustín Alfonso, Ramirez, F Daniel, Constantin, Marion, Bortone, Clara, Hébert, Caroline, Constantin, Justine, Bialas, Patric, Limite, Luca Rosario
Format:	Journal Article
Language:	English
Published:	US Oxford University Press 02-11-2023
Subjects:	Adult Animals Atrial Fibrillation - pathology Atrial Fibrillation - surgery Catheter Ablation - adverse effects Catheter Ablation - methods Catheters Heart Atria - pathology Heart Atria - surgery Humans Lung Diseases, Interstitial - pathology Lung Diseases, Interstitial - surgery Pulmonary Veins - surgery Sheep Translational Research Treatment Outcome Thin-walled structures Ovine model Atrial fibrillation High-power Interlesion distance Radiofrequency Pulmonary vein isolation
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Summary:	Abstract Aims The optimal interlesion distance (ILD) for 90 and 50 W radiofrequency applications with low ablation index (AI) values in the atria has not been established. Excessive ILDs can predispose to interlesion gaps, whereas restrictive ILDs can predispose to procedural complications. The present study sought, therefore, to experimentally determine the optimal ILD for 90 W–4 s and 50 W applications with low AI values to optimize catheter ablation outcomes in humans. Methods and results Posterior intercaval lines were created in eight adult sheep using CARTO and the QDOT-MICRO catheter in a temperature-controlled mode. In four animals, the lines were created with 50 W applications, a target AI value ≥350, and ILDs of 6, 5, 4, and 3 mm, respectively. In the other four animals, the lines were created with 90 W–4 s applications and ILDs of 6, 5, 4, and 3 mm, respectively. Activation maps were created immediately after ablation and at 21 days to assess linear block prior to gross and histological analyses. All eight lines appeared transmural and continuous on histology. However, for 50 W-only applications with an ILD of 3 mm resulted in durable linear electrical block, whereas for 90 W applications, only the lines with ILDs of 4 and 3 mm were blocked. No complications were detected during ablation procedures, but all power and ILD combinations except 50 W–6 mm resulted in asymptomatic shallow lung lesions. Conclusion In the intercaval region in sheep, for 50 W applications with an AI value of ∼370, the optimal ILD is 3 mm, whereas for 90 W–4 s applications, the optimal ILD is 3–4 mm. Graphical Abstract Graphical abstract
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1099-5129 1532-2092
DOI:	10.1093/europace/euad310