Char Formation During Very High-Power Short-Duration Ablation for Atrial Fibrillation.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Pulmonary vein (PV) isolation using very high-power short-duration (vHPSD) radiofrequency catheter ablation is a key treatment for atrial fibrillation.
• vHPSD ablation carries a risk of char formation, necessitating investigation into its incidence and predictors.

Purpose of the Study:

• To assess the incidence of char formation during vHPSD pulmonary vein isolation (PVI).
• To identify patient characteristics and procedural factors associated with char formation during vHPSD-PVI.

Main Methods:

• Prospective study of 50 patients undergoing initial PVI with a QDOT MICRO™ catheter in vHPSD setting (90W/4s).
• PVs were divided into eight segments; char formation was evaluated post-ablation.
• Analysis of patient characteristics and procedural parameters to identify risk factors.

Main Results:

• Char formation occurred in 48.0% of patients, predominantly in the right inferior PV segments.
• Higher left atrial volume index (LAVI) and parallel catheter orientation were independent predictors of char formation.
• One patient with char formation experienced symptomatic thromboembolism.

Conclusions:

• Char formation is a significant complication of vHPSD-PVI, observed in 48.0% of patients.
• Risk factors include application to the right inferior PV, higher LAVI, and parallel catheter orientation.
• vHPSD applications should be approached cautiously in these specific conditions to mitigate char formation risk.