Efficacy of high-power and short-duration ablation in patients with atrial fibrillation: a prospective randomized controlled trial

Abstract

Aims The formation of radiofrequency lesions depends on the power and duration of ablation, and the contact force (CF). Although high power (HP) creates continuous and transmural lesions, most centres still use 25–30 W for 30–40 s for safety reasons. We evaluated the clinical efficacy and safety of a HP and short-duration (HPSD) strategy for atrial fibrillation (AF) ablation. Methods and results One hundred and fifty patients [58.2 ± 10.0 years, 48% with paroxysmal AF (PAF)] scheduled for index AF ablation using a CF-sensing catheter were randomly assigned to three groups [30 W, 40 W, and 50 W at ablation sites of anterior, roof, and inferior segments of pulmonary vein (PV) antra and roof line between each upper PV]. In 25–30 W for ≤20 s was applied at posterior wall ablation site in all subjects. Compared with the 30 W and 40 W groups, procedure (P < 0.001) and ablation times (P < 0.001) were shorter and ablation number for PV isolation (P < 0.001) was smaller in the 50 W group. There were no significant differences in the CF and ablation index (AI) among the three groups. There were no significant differences in the procedure-related complication rates. During the 12-month follow-up, AF recurred in 24 (16%) patients with no significant difference among the groups (P = 0.769). In the multivariate analysis, non-PAF [hazard ratio (HR) 2.836, P = 0.045] and AI (HR 0.983, P = 0.001) were independent risk factors for AF recurrence. Conclusion Radiofrequency ablation with HPSD is a safe and effective strategy with reduced ablation number and shortened procedure time compared to conventional ablation.

Comparison of high‐power short‐duration and low‐power long‐duration radiofrequency ablation for treating atrial fibrillation: Systematic review and meta‐analysis

“…And then, two trails by Berte B et al 14 and Dhillon G et al 15 comparing HPSD and LPLD were excluded because their ablations were guided by the ablation index (AI) without illustrating ablation time per site details. Consequently, 10 clinical trials with 2467 patients were enrolled in this meta‐analysis 8,16‐24 …”

“…Moreover, in the most of studies consecutive patients receiving HPSD were compared with patients who were age and sex matched but treated with LPLD. Additionally, all patients received PVI, and additional linear ablations were performed in select patients at the operator's discretion in some trials 8,16,18,21,24 . All studies had good methodological qualities.…”

“…In the anterior of PVs, the power and ablation time would be increased appropriately, but in the posterior, the power and ablation time would be reduced. For the LPLD group, some studies performed ablation within a specific range (20‐40 W), 8,17‐20,23,24 and others had powers set to 30W 16,21,22 . In our analysis, we defined LPLD as having an ablation power of 20 to 40 W for 10 to 30s per site.…”

“…Consequently, 10 clinical trials with 2467 patients were enrolled in this meta-analysis. 8,[16][17][18][19][20][21][22][23][24]…”

“…Some trails included other characteristics like as left atrial size, left atrial volume, rate of hypertension, diabetes mellitus, coronary artery disease, heart failure and transient ischemic attack/stroke. Six of ten were prospective studies [17][18][19][20][21]23 , and one was RCT. 21 The meta-regression analysis revealed that no baseline characteristics could affect the correlation between two groups.…”