While the landscape of atrial fibrillation (AF) ablation is changing rapidly, radiofrequency (RF) remains the current gold standard. Approaches such as very high power, very short duration (vHPvSD) ablation, using 90 W 4 s lesions, attempts to improve safety outcomes by altering the lesion profile such that damage to surrounding noncardiac structures is potentially minimized. 1,2 It is reasonable to assume that ablation and procedural times are also likely to be improved. However, these benefits are likely to be more relevant if clinical outcomes with vHPvSD are at least noninferior to standard RF ablation. Is this the case?We recently reviewed data from initial vHPvSD studies showing somewhat disappointing first pass isolation (FPI) and acute reconnection rates compared with standard RF ablation (sRF). 3 It is important to note that whilst these parameters are excellent acute markers for clinical efficacy, they are not a substitute for clinical outcome data on follow up. In this edition of the Journal of Cardiovascular Electrophysiology, Mueller and colleagues present the results of a single center, retrospective, propensity matched study comparing 12-month outcomes of ablation with 90 W (vHPvSD)versus Ablation Index (AI) guided 50 W (sRF) in 84 patients. 4 They found that 90 W vHPvSD ablation was associated with shorter ablation times (10.5 vs. 17.4 min; p = .001), but with lower FPI rates (40% vs. 62%; p = .049), higher AF recurrence during the blanking period (38% vs. 12%; p = .007), and a trend towards a lower freedom from AF at 12 months (62% vs. 75%; p = .071).