Incidence and Influencing Factors for Steam Pops in Cardiac Ablations: A Systematic Review

Steam pops (SPs) during cardiac ablations have emerged as a notable phenomenon with potential implications for procedural safety and efficacy. This is the first review of SPs, which aims to explore the current understanding of SPs. The review investigates their incidence, associations, predictors, clinical significance, and management strategies. Presently, the factors that give rise to SPs have not been completely understood, and the root cause of SPs remains elusive. To achieve this goal, the study conducted a comprehensive review of existing research on SPs in cardiac ablation procedures to ascertain the prevalence and predictors of SPs.

The research involved an extensive search of databases from their inception until April 2024 to investigate the prevalence of SPs during cardiac ablation procedures in humans. The primary objective of this study was to gather patient demographics, incidence rates, and potential risk factors and predictors that could contribute to the occurrence of SPs and determine any significant correlations between them. The data collected were thoroughly reviewed to identify any significant associations between the various risk factors, predictors, and the incidence of SPs.

A comprehensive review of literature sourced from EMBASE and PubMed identified 25 relevant studies focused on the incidence and clinical significance of steam pops (SPs) during catheter ablation procedures. The studies reported varying rates of SPs, ranging from 0% to 26%, with the highest incidence observed in atrial fibrillation (AFib) and ventricular ablation cases. The association between SPs and factors such as catheter type, irrigation methods, and monitoring parameters was assessed. Notably, advanced catheter technologies, such as the QDOT MICRO and THERMOCOOL SMARTTOUCH, demonstrated a significant reduction in SP occurrences. Additionally, the analysis highlighted the role of temperature control and contact force in minimizing the risk of SPs, with temperature-controlled ablation (TCA) generally leading to fewer SPs compared to power-controlled ablation (PCA). Despite the low incidence of severe complications, the review underscores the importance of careful monitoring of impedance and real-time feedback during ablation to ensure patient safety.

SPs are not uncommon during ablation procedures with irrigated catheters. Caution is required to avoid temperature feedback issues. Advanced catheters are associated with a reduced incidence of steam pops. The risks can be minimized by decreasing energy settings and monitoring impedance changes.