The “16‐gram window” of contact‐force: A new criterion for very high‐power short‐duration ablation
Abstract Background Very high‐power short‐duration (vHPSD) ablation with the novel QDOT™ catheter allows the regulation of target temperature by automatically adjusting flow and power during a 4 s application of 90 W. However, the optimal contact force for sufficient lesion creation is unknown. Meth...
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| Format: | Article |
| Language: | English |
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Wiley
2025-06-01
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| Series: | Journal of Arrhythmia |
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| Online Access: | https://doi.org/10.1002/joa3.70076 |
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| author | Dimitrios Bismpos Jan Wintrich Valerie Pavlicek Raphael Spittler Alexander P. Benz Michael Böhm German Fernandez Ferro Felix Mahfoud Thomas Rostock Christian Ukena |
| author_facet | Dimitrios Bismpos Jan Wintrich Valerie Pavlicek Raphael Spittler Alexander P. Benz Michael Böhm German Fernandez Ferro Felix Mahfoud Thomas Rostock Christian Ukena |
| author_sort | Dimitrios Bismpos |
| collection | DOAJ |
| description | Abstract Background Very high‐power short‐duration (vHPSD) ablation with the novel QDOT™ catheter allows the regulation of target temperature by automatically adjusting flow and power during a 4 s application of 90 W. However, the optimal contact force for sufficient lesion creation is unknown. Methods We enrolled 73 patients with symptomatic atrial fibrillation undergoing pulmonary vein isolation (PVI) using the QDOT catheter in the vHPSD mode (90 W, 4 s). Ablation metrics associated with suboptimal applications, defined as either an impedance drop of ≤5% or a cumulative temperature‐limited energy ≤330 J, were collected and analyzed. Results A total of 3881 vHPSD applications (53.2 applications per patient) with a mean contact force (CF) of 12.8 ± 6.6 g were analyzed. Significant CF variability and intermittent loss of contact were documented in 18.2% and 8.8% of the applications, respectively. A ΔImp ≤ 5% occurred in 3.9% of vHPSD applications, while a cumulative energy ≤ 330 J was observed in 3% of the applications. Applications with a mean CF < 6 g and >22 g were associated with an inadequate impedance drop (10.3%, Phi coefficient 0.118, p < .001) and total applied energy (7.8%, Phi coefficient 0.094, p < .001) respectively. At superior PV segments with thick atrial walls, significantly more applications with cumulative energy ≤330 J (4.2% vs. 2.5%; p = .007) were observed, especially when mean CF > 18 g was applied (8.4%, Phi coefficient 0.093, p = .003). Conclusion A lower but also a higher mean contact‐force was associated with suboptimal vHPSD applications. Hence, a “16‐gram window” of contact‐force, from 6 to 22 g, could optimize energy application in vHPSD ablation. |
| format | Article |
| id | doaj-art-466e8ecfcd2a44e2b4e5d3be398e7bcd |
| institution | Kabale University |
| issn | 1880-4276 1883-2148 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
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| series | Journal of Arrhythmia |
| spelling | doaj-art-466e8ecfcd2a44e2b4e5d3be398e7bcd2025-08-20T03:27:11ZengWileyJournal of Arrhythmia1880-42761883-21482025-06-01413n/an/a10.1002/joa3.70076The “16‐gram window” of contact‐force: A new criterion for very high‐power short‐duration ablationDimitrios Bismpos0Jan Wintrich1Valerie Pavlicek2Raphael Spittler3Alexander P. Benz4Michael Böhm5German Fernandez Ferro6Felix Mahfoud7Thomas Rostock8Christian Ukena9Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland University Homburg Saar GermanyDepartment of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland University Homburg Saar GermanyDepartment of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland University Homburg Saar GermanyDepartment of Cardiology II/Electrophysiology, Center for Cardiology University Hospital Mainz Mainz GermanyDepartment of Cardiology II/Electrophysiology, Center for Cardiology University Hospital Mainz Mainz GermanyDepartment of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland University Homburg Saar GermanyDepartment of Cardiology II/Electrophysiology, Center for Cardiology University Hospital Mainz Mainz GermanyDepartment of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland University Homburg Saar GermanyDepartment of Cardiology II/Electrophysiology, Center for Cardiology University Hospital Mainz Mainz GermanyDepartment of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Saarland University Homburg Saar GermanyAbstract Background Very high‐power short‐duration (vHPSD) ablation with the novel QDOT™ catheter allows the regulation of target temperature by automatically adjusting flow and power during a 4 s application of 90 W. However, the optimal contact force for sufficient lesion creation is unknown. Methods We enrolled 73 patients with symptomatic atrial fibrillation undergoing pulmonary vein isolation (PVI) using the QDOT catheter in the vHPSD mode (90 W, 4 s). Ablation metrics associated with suboptimal applications, defined as either an impedance drop of ≤5% or a cumulative temperature‐limited energy ≤330 J, were collected and analyzed. Results A total of 3881 vHPSD applications (53.2 applications per patient) with a mean contact force (CF) of 12.8 ± 6.6 g were analyzed. Significant CF variability and intermittent loss of contact were documented in 18.2% and 8.8% of the applications, respectively. A ΔImp ≤ 5% occurred in 3.9% of vHPSD applications, while a cumulative energy ≤ 330 J was observed in 3% of the applications. Applications with a mean CF < 6 g and >22 g were associated with an inadequate impedance drop (10.3%, Phi coefficient 0.118, p < .001) and total applied energy (7.8%, Phi coefficient 0.094, p < .001) respectively. At superior PV segments with thick atrial walls, significantly more applications with cumulative energy ≤330 J (4.2% vs. 2.5%; p = .007) were observed, especially when mean CF > 18 g was applied (8.4%, Phi coefficient 0.093, p = .003). Conclusion A lower but also a higher mean contact‐force was associated with suboptimal vHPSD applications. Hence, a “16‐gram window” of contact‐force, from 6 to 22 g, could optimize energy application in vHPSD ablation.https://doi.org/10.1002/joa3.70076atrial fibrillationcontact‐force sensing ablationpulmonary vein isolationradiofrequency ablationvery high‐power short‐duration ablation |
| spellingShingle | Dimitrios Bismpos Jan Wintrich Valerie Pavlicek Raphael Spittler Alexander P. Benz Michael Böhm German Fernandez Ferro Felix Mahfoud Thomas Rostock Christian Ukena The “16‐gram window” of contact‐force: A new criterion for very high‐power short‐duration ablation Journal of Arrhythmia atrial fibrillation contact‐force sensing ablation pulmonary vein isolation radiofrequency ablation very high‐power short‐duration ablation |
| title | The “16‐gram window” of contact‐force: A new criterion for very high‐power short‐duration ablation |
| title_full | The “16‐gram window” of contact‐force: A new criterion for very high‐power short‐duration ablation |
| title_fullStr | The “16‐gram window” of contact‐force: A new criterion for very high‐power short‐duration ablation |
| title_full_unstemmed | The “16‐gram window” of contact‐force: A new criterion for very high‐power short‐duration ablation |
| title_short | The “16‐gram window” of contact‐force: A new criterion for very high‐power short‐duration ablation |
| title_sort | 16 gram window of contact force a new criterion for very high power short duration ablation |
| topic | atrial fibrillation contact‐force sensing ablation pulmonary vein isolation radiofrequency ablation very high‐power short‐duration ablation |
| url | https://doi.org/10.1002/joa3.70076 |
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