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.