How should a steam pop be handled during RF ablation?

• A. Pause RF immediately, assess tissue and catheter stability, switch to lower energy or switch modality; monitor for complications.
• B. Increase RF power.
• C. Continue RF at current settings.
• D. Switch to cryoablation without pausing.

Answer: (A)

Steam pops signal dangerous overheating during RF ablation. They occur when tissue heats so rapidly that contained water boils and creates a disruptive bubble, which can tear tissue, cause char and thrombus, or even perforation leading to tamponade. Because of this risk, the immediate move is to stop delivering RF energy right away and reassess what’s happening at the site.

Pause RF and check both the tissue and the catheter. Confirm that the catheter hasn’t moved and that contact is stable, then reconsider the energy plan. Lower the power or shorten the duration if you resume the ablation, or switch to a different energy modality such as cryoablation. The goal is to continue lesion formation safely without provoking another steam pop. Throughout, monitor for complications like pericardial effusion and be prepared to image and intervene if needed.

Other approaches that push ahead with the same settings or increase energy would raise the risk of another steam pop and potential injury, and switching to cryo without first pausing would skip the essential safety check after a plausible perforation risk is identified.