Background:High-power short-duration (HP-SD) radiofrequency ablation (RFA) has been proposed as a method for producing rapid and effective lesions for pulmonary vein isolation. The underlying hypothesis assumes an increased resistive heating phase and decreased conductive heating phase, potentially reducing the risk for esophageal thermal injury. The objective of this study was to compare the esophageal temperature dynamic profile between HP-SD and moderate-power moderate-duration (MP-MD) RFA ablation strategies.Methods:In patients undergoing pulmonary vein isolation, RFA juxtaposed to the esophagus was delivered in an alternate sequence of HP-SD (50 W, 8–10 s) and MP-MD (25 W, 15–20 s) between adjacent applications (distance, ≤4 mm). Esophageal temperature was recorded using a multisensor probe (CIRCA S-CATH). Temperature data included magnitude of temperature rise, maximal temperature, time to maximal temperature, and time return to baseline. In swine, a similar experimental design compared the effect of HP-SD and MP-MD on patterns of esophageal injury.Results:In 20 patients (68.9±5.8 years old; 60% persistent atrial fibrillation), 55 paired HP-SD and MP-MD applications were analyzed. The esophageal temperature dynamic profile was similar between HP-SD and MP-MD ablation strategies. Specifically, the magnitude of temperature rise (2.1 °C [1.4–3] versus 2.0 °C [1.5–3]; P=0.22), maximal temperature (38.4 °C [37.8–39.3] versus 38.5 °C [37.9–39.4]; P=0.17), time to maximal temperature (24.9±7.5 versus 26.3±6.8 s; P=0.1), and time of temperature to return to baseline (110±23.2 versus 111±25.1 s; P=0.86) were similar between HP-SD and MP-MD ablation strategies. In 6 swine, esophageal injury was qualitatively similar between HP-SD and MP-MD strategies.Conclusions:Esophageal temperature dynamics are similar between HP-SD and MP-MD RFA strategies and result in comparable esophageal tissue injury. Therefore, when using a HP-SD RFA strategy, the shorter application duration should not prompt shorter intervals between applications.

中文翻译：

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高功率短时射频消融对食管温度动态的影响

背景：高功率短时 (HP-SD) 射频消融 (RFA) 已被提议作为一种产生用于肺静脉隔离的快速有效病变的方法。基本假设假设电阻加热阶段增加而传导加热阶段减少，这可能会降低食管热损伤的风险。本研究的目的是比较 HP-SD 和中等功率中等持续时间 (MP-MD) RFA 消融策略之间的食管温度动态曲线。方法：在接受肺静脉隔离的患者中，RFA 与食管并列在相邻应用程序之间的 HP-SD（50 W，8-10 秒）和 MP-MD（25 W，15-20 秒）交替序列（距离，≤ 4 毫米）。使用多传感器探针（CIRCA S-CATH）记录食道温度。温度数据包括温升幅度、最高温度、达到最高温度的时间和返回基线的时间。在猪中，类似的实验设计比较了 HP-SD 和 MP-MD 对食管损伤模式的影响。结果：在 20 名患者（68.9±5.8 岁；60% 持续性心房颤动）中，55 对 HP-SD 和 MP - MD 应用程序进行了分析。HP-SD 和 MP-MD 消融策略的食管温度动态曲线相似。具体而言，温升幅度（2.1 °C [1.4–3] 对 2.0 °C [1.5–3]；60% 持续性心房颤动），分析了 55 对 HP-SD 和 MP-MD 应用。HP-SD 和 MP-MD 消融策略的食管温度动态曲线相似。具体而言，温升幅度（2.1 °C [1.4–3] 对 2.0 °C [1.5–3]；60% 持续性心房颤动），分析了 55 对 HP-SD 和 MP-MD 应用。HP-SD 和 MP-MD 消融策略的食管温度动态曲线相似。具体而言，温升幅度（2.1 °C [1.4–3] 对 2.0 °C [1.5–3]；P = 0.22），最高温度（38.4 °C [37.8–39.3] vs 38.5 °C [37.9–39.4]；P =0.17），达到最高温度的时间（24.9±7.5 vs 26.3±6.8 s；P =0.1），HP-SD 和 MP-MD 消融策略之间的温度和返回基线的时间（110±23.2 与 111±25.1 秒；P = 0.86）相似。在 6 头猪中，HP-SD 和 MP-MD 策略之间的食管损伤在性质上相似。结论：HP-SD 和 MP-MD RFA 策略之间的食管温度动力学相似，并导致可比的食管组织损伤。因此，在使用 HP-SD RFA 策略时，较短的应用程序持续时间不应促使应用程序之间的间隔更短。