title: Five seconds of 50-60 W radio frequency atrial ablations were transmural and safe: an in vitro mechanistic assessment and force-controlled in vivo validation.
abstract: OBJECTIVE
  Longer procedural time is associated with complications in radiofrequency atrial fibrillation ablation. We sought to reduce ablation time and thereby potentially reduce complications. The aim was to compare the dimensions and complications of 40 W/30 s setting to that of high-power ablations (50-80 W) for 5 s in the in vitro and in vivo models.
  
  
  RESULTS
  In vitro ablations-40 W/30 s were compared with 40-80 W powers for 5 s. In vivo ablations-40 W/30 s were compared with 50-80 W powers for 5 s. All in vivo ablations were performed with 10 g contact force and 30 mL/min irrigation rate. Steam pops and depth of lung lesions identified post-mortem were noted as complications. A total of 72 lesions on the non-trabeculated part of right atrium were performed in 10 Ovine. All in vitro ablations except for the 40 W/5 s setting achieved the critical lesion depth of 2 mm. For in vivo ablations, all lesions were transmural, and the lesion depths for the settings of 40 W/30 s, 50 W/5 s, 60 W/5 s, 70 W/5 s, and 80 W/5 s were 2.2 ± 0.5, 2.3 ± 0.5, 2.1 ± 0.4, 2.0 ± 0.3, and 2.3 ± 0.7 mm, respectively. The lesion depths of short-duration ablations were similar to that of the conventional ablation. Steam pops occurred in the ablation settings of 40 W/30 s and 80 W/5 s in 8 and 11% of ablations, respectively. Complications were absent in short-duration ablations of 50 and 60 W.
  
  
  CONCLUSIONS
  High-power, short-duration atrial ablation was as safe and effective as the conventional ablation. Compared with the conventional 40 W/30 s setting, 50 and 60 W ablation for 5 s achieved transmurality and had fewer complications.
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Bhaskaran
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Chik
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Jim
authors.initials: J
authors.lastname: Pouliopoulos
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Chrishan
authors.initials: C
authors.lastname: Nalliah
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Pierre
authors.initials: P
authors.lastname: Qian
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.|School of Electrical and Information Engineering, University of Sydney, Sydney, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Barry
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Fazlur
authors.initials: F
authors.lastname: Nadri
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Rahul
authors.initials: R
authors.lastname: Samanta
authors.affiliation: Biotronik company, Sydney, NSW 2073, Australia.
authors.forename: Ying
authors.initials: Y
authors.lastname: Tran
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Stuart
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Pramesh
authors.initials: P
authors.lastname: Kovoor
authors.affiliation: Cardiology Department, Westmead Hospital, Corner Darcy and Hawkesbury Road, Westmead, Sydney, NSW 2145, Australia.|Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Aravinda
authors.initials: A
authors.lastname: Thiagalingam
mesh_terms: D000818:Animals; D002058:Burns, Electric / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D006325:Heart Atria / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D006329:Heart Conduction System / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D066298:In Vitro Techniques; D061646:Operative Time; D011829:Radiation Dosage; D012756:Sheep; D013314:Stress, Mechanical
keywords: Atrial fibrillation ablation; High power; Radiofrequency ablation; Safety; Short duration