Limitations of very HPSD ablation
Masateru et al could demonstrated that the beneficial lesion geometry using the QDOT catheter in an ex vivo porcine model with a temperature controlled ablation mode is found as well (14). Our data show that especially in areas with thicker tissue (like the ridge between the left superior vein and the left atrial appendage) the ablation mode had to be changed to lower power for longer duration (50watts/15seconds) significantly more often to achieve durable lesions. These findings are in line with Yavin et al who demonstrated that HPSD ablation with 50 watts for the ablation of the mitral isthmus only led to successful mitral isthmus block in 43% of patients versus 70% of the control group using standard power settings (6). These findings support the assumption; the application of lower power for longer duration leads to deeper and more sufficient lesions in thicker myocardial structures.