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      High-power, Short-duration Radiofrequency Ablation for the Treatment of AF

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          Abstract

          High-power, short-duration (HPSD) ablation for the treatment of AF is emerging as an alternative to ablation using conventional ablation generator settings characterised by lower power and longer duration. Although the reported potential advantages of HPSD ablation include less tissue oedema and collateral tissue damage, a reduction in procedural time and superior ablation lesion formation, clinical studies of HPSD ablation validating these observations are limited. One of the main challenges for HPSD ablation has been the inability to adequately assess temperature and lesion formation in real time. Novel catheter designs may improve the accuracy of intra-ablation temperature recording and correspondingly may improve the safety profile of HPSD ablation. Clinical studies of HPSD ablation are on-going and interpretation of the data from these and other studies will be required to ascertain the clinical value of HPSD ablation.

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          Most cited references40

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          Paroxysmal AF catheter ablation with a contact force sensing catheter: results of the prospective, multicenter SMART-AF trial.

          Catheter ablation is important for treatment of paroxysmal atrial fibrillation (PAF). Limited animal and human studies suggest a correlation between electrode-tissue contact and radiofrequency lesion generation.
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            Randomized, Controlled Trial of the Safety and Effectiveness of a Contact Force-Sensing Irrigated Catheter for Ablation of Paroxysmal Atrial Fibrillation: Results of the TactiCath Contact Force Ablation Catheter Study for Atrial Fibrillation (TOCCASTAR) Study.

            Contact force (CF) is a major determinant of lesion size and transmurality and has the potential to improve efficacy of atrial fibrillation ablation. This study sought to evaluate the safety and effectiveness of a novel irrigated radiofrequency ablation catheter that measures real-time CF in the treatment of patients with paroxysmal atrial fibrillation.
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              Anatomy of the left atrium: implications for radiofrequency ablation of atrial fibrillation.

              The feasibility of treating atrial fibrillation with radiofrequency ablation has revived interest in the structure of the left atrium, a chamber that has been neglected in many textbooks of anatomy. We reviewed the gross structure of the left atrium by examining the septum, the appendage, and insertions of the pulmonary veins in normal hearts. The limited extent of the true septal component is relevant to procedures using the transseptal approach. On gross examination, the musculature of the atrial wall is composed of overlapping bundles of aligned fibers that, in the majority of hearts, are arranged in characteristic patterns with only minor individual variations. Muscular sleeves extend into the walls of the pulmonary veins to varying distances. The longest sleeves are in the left upper veins. Bachmann's bundle anteriorly, and other smaller bundles superiorly and posteriorly, bridge the septal raphe to blend with musculature of the right atrium. Tongues of left atrial musculature from the posterior wall also extend into the wall of the coronary sinus. The left atrium is more complex than usually conceived. Understanding its structure, and the arrangement of its musculature, will help in improving strategies for linear lesions when attempting to compartmentalize the chamber, or when placing focal lesions for ablating ectopic sources.
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                Author and article information

                Journal
                Arrhythm Electrophysiol Rev
                Arrhythm Electrophysiol Rev
                AER
                Arrhythmia & Electrophysiology Review
                Radcliffe Cardiology
                2050-3369
                2050-3377
                12 February 2020
                : 8
                : 4
                : 265-272
                Affiliations
                [1. ] Guy’s and St Thomas’ NHS Foundation Trust, London, UK
                [2. ] King’s College London, UK
                Author notes

                Disclosure: MO has received research support and honoraria from Biosense Webster and consultation fees from Medtronic, Biosense Webster, St Jude/Abbott and Siemens. SEW has received research support from Biosense Webster. IDK has no conflicts of interest to declare.

                Correspondence: Irum D Kotadia, Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor North Wing, St Thomas’ Hospital, 249 Westminster Bridge Rd, London SE1 7EH, UK. E: irum.kotadia@ 123456kcl.ac.uk
                Article
                10.15420/aer.2019.09
                7358956
                32685157
                1c4a1cb0-34e0-447a-a340-2521d9485c34
                Copyright © 2019, Radcliffe Cardiology

                This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.

                History
                : 10 August 2019
                : 09 September 2019
                Page count
                Pages: 8
                Categories
                Electrophysiology and Ablation

                high-power,short-duration ablation,radiofrequency ablation lesion formation,af

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