High-Power, Short-Duration Ablation under the Guidance of Relatively Low Ablation Index Values for Paroxysmal Atrial Fibrillation: Long-Term Outcomes and Characteristics of Recurrent Atrial Arrhythmias

Abstract

Objective: The purpose of this study was to evaluate the difference in effectiveness and safety of high-power, short-duration (HPSD) radiofrequency catheter ablation (RFA) guided by relatively low ablation index (AI) values and conventional RFA in paroxysmal atrial fibrillation (PAF) patients. Methods: The HPSD RFA strategy (40–50 W, AI 350–400 for anterior, 320–350 for posterior wall; n = 547) was compared with the conventional RFA strategy (25–40 W, without AI; n = 396) in PAF patients who underwent their first ablation. Propensity-score matching analyses were used to compare the outcomes of the two groups while controlling for confounders. Results: After using propensity-score matching analysis, the HPSD group showed a higher early recurrence rate (22.727% vs. 13.636%, p = 0.003), similar late recurrence rate, and comparable safety (p = 0.604) compared with the conventional group. For late recurrent atrial arrhythmia types, the rate of regular atrial tachycardia was significantly higher in the HPSD group (p = 0.013). Additionally, the rate of chronic pulmonary vein reconnection and non-pulmonary vein triggers during repeat procedures was similar in both groups. Conclusions: For PAF patients, compared with the conventional RFA strategy, the HPSD RFA strategy at relatively low AI settings had a higher early recurrence rate, similar long-term success rate, and comparable safety.

High Power Short Duration vs Low Power Long Duration Catheter Ablation of Atrial Fibrillation

“…All six studies were in agreement that HPSD had comparable safety to LPLD without any difference in both acute and long-term complications (11,12,15,17,18,23). The incidence of acute complications including: ETI, pericardial effusion, tamponade, stroke, PV stenosis, phrenic nerve paralysis, atrioesophageal fistulas, and death (11,17,18,23). Meanwhile, another frequent acute complication of AF, silent cerebral embolism (SCE) was evaluated by Chen et al (2023) through Diffusion-weighted magnetic resonance imaging (DWI).…”

“…Out of ten included studies, six investigated the safety of HPSD ablation compared to LPLD. All six studies were in agreement that HPSD had comparable safety to LPLD without any difference in both acute and long-term complications (11,12,15,17,18,23). The incidence of acute complications including: ETI, pericardial effusion, tamponade, stroke, PV stenosis, phrenic nerve paralysis, atrioesophageal fistulas, and death (11,17,18,23).…”

“…confirmed that HPSD had similar rate of ETI compared to LPLD. In addition, there was no significant difference in the incidence of pericardial effusion and tamponade, further confirming that HPSD is a safe choice (11,17,18,23). However, HPSD should be avoided in patients with enlarged LA diameter and those with short atrium-to-esophagus distance (<2 mm) as it increases the risk of ETI (28).…”

“…Five studies were in agreement that HPSD ablation was superior in maintaining freedom of AF after ablation during one year follow up period (16,17,19) and three months follow up period (21). 2023) disagreed and found that HPSD ablation was associated with higher recurrence rate within the blanking period of three months after ablation but had similar efficacy to LPLD in long term maintenance of sinus rhythm (23).…”

Catheter Ablation of Atrial Fibrillation with Short Duration Radiofrequency Current using Non-Irrigated Catheters

“…Застосування радіочастотного струму високої потужності вважається багатообіцяючою альтернативою методиці катетерної абляції фібриляції передсердь (ФП) з використанням радіочастотного струму звичайної потужності [1]. Звичайною вважають потужність 20-35 Вт по задній стінці лівого передсердя та 35-40 Вт в інших ділянках [2]. Потужність 40-90 Вт вважається високою і потребує зменшення часу впливу [1].…”