Efficacy and Safety of High‐Power Short‐Duration Ablation for Cavo‐Tricuspid Isthmus With a Flexible‐Tip Temperature‐Controlled Power Regulation Catheter Performed by Electrophysiology Trainees

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Abstract
Introduction: The suitability of high‐power short‐duration (HPSD) cavo‐tricuspid isthmus ablation (CTI‐Abl) for electrophysiology (EP) trainees, as well as the underlying mechanisms of its efficacy, remain unknown. The aim of this study was to clarify the efficacy and safety of HPSD CTI‐Abl performed by EP trainees and assess lesion characteristics between HPSD and moderate‐power long duration (MPLD) ablations.Methods: Study 1: CTI‐Abl was performed by first‐ to fourth‐year EP trainees in consecutive 113 patients (67 ± 11 years, 27.2% female). Study cohort was historically divided into three groups: MPLD (30–35 W for up to 30 s) using TactiCath (TC‐MPLD, N = 38) and MPLD and HPSD (50 W for 12 s) using TactiFlex (TF‐MPLD, N = 23; TF‐HPSD, N = 52). Primary endpoint was first‐pass bidirectional isthmus block (BIB). Study 2: lesion geometries created by each ablation strategy were compared using an ex‐vivo model.Results: Study 1: TF‐HPSD ablation strategy demonstrated a higher success rate of first‐pass BIB than MPLD protocol (TC‐MPLD, 58%; TF‐MPLD, 48%; TF‐HPSD, 94%, p < 0.001), without any complications. TF‐HPSD group was associated with shorter total procedure and RF application times, as well as fewer ablation points and gaps, compared to the MPLD groups. Study 2: TF‐HPSD created greater lesion surface length, width, and area than MPLD strategies.Conclusion: HPSD CTI‐Abl performed by EP trainees using TactiFlex SE catheter demonstrated a higher first‐pass BIB rate, shorter total procedure and RF application times, and fewer ablation points and gaps compared to the conventional method, without increasing complication rates.

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