Avoiding Microbubbles Formation During Radiofrequency Left Atrial Ablation Versus Continuous Microbubbles Formation and Standard Radiofrequency Ablation Protocols: Comparison of Energy Profiles and Chronic Lesion Characteristics

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Abstract
Background: Radiofrequency (RF) energy parameters and chronic lesion characteristics associated with the microbubbles formation have not been yet fully elucidated. Objectives: The objective of this study was to compare the energy profiles and chronic lesion characteristics associated with RF ablation of the pulmonary vein antrum using three different ablation protocols: (1) avoiding microbubbles; (2) continuous microbubble formation; (3) temperature‐guided ablation. Methods: A 4‐mm tip ablation catheter was used for creating RF ablation lesions in 15 adult mongrel dogs. All ablation lesions were created at the posterior aspect of the PV antrum in each animal. Avoiding microbubbles (group 1, n = 5 dogs, 23 lesions), continuous microbubble formation (group 2, n = 5 dogs, 22 lesions), and temperature‐guided (group 3, n = 5 dogs, 19 lesions, target temperature 60°C/power limit 50 W) ablation lesions were analyzed. Results: Group 1 showed significantly lower power (19 ± 8.6 W), lower temperature (50 ± 4.8°C), higher efficiency‐of‐heating index (2.9 ± 0.8°C/W), and lower impedance (109 ± 24.4 Ω) than groups 2 (38 ± 8.4 W; 63 ± 10°C; 1.8 ± 0.8°C/W; 148 ± 34.4 Ω) and 3 (44 ± 12 W; 57 ± 2.4°C; 1.4 ± 0.5°C/W; 139 ± 23.1 Ω) (P < 0.001 vs groups 2 and 3). During ablation, no significant events were detected in group 1, but 11 cases of audible pop, 11 cases of catheter tip charring, and 1 case of fatal myocardial perforation were observed in groups 2 and 3. Transmural lesions were more frequently created in group 1. Conclusion: RF energy delivery applying “avoiding microbubbles” protocol seems to be associated with higher degree of safety and efficacy when compared to temperature‐guided and continuous microbubble‐formation ablation protocols.

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