Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Abstract

Aims Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) in patients with paroxysmal atrial fibrillation (PAF) is effective but hampered by pulmonary vein reconnection due to insufficient ablation lesions. High-power delivery over a short period of time (HPSD) in RFA is stated to create more efficient lesions. The aim of this study was to compare intraprocedural safety and outcome of HPSD ablation to conventional power settings in patients undergoing PVI for PAF. Methods and results We included 197 patients with PAF that were scheduled for PVI. An ablation protocol with 70 W and a duration cut-off of 7 s at the anterior left atrium (LA) and 5 s at the posterior LA (HPSD group; n = 97) was compared to a conventional power protocol with 30–40 W for 20–40 s (standard group; n = 100) in terms of periprocedural complications and a 1-year outcome. The HPSD group showed significantly less arrhythmia recurrence during 1-year follow-up with 83.1% of patients free from atrial fibrillation compared to 65.1% in the standard group (P < 0.013). No pericardial tamponade, periprocedural thromboembolic complications, or atrio-oesophageal fistula occurred in either group. Mean radiofrequency time (12.4 ± 3.4 min vs. 35.6 ± 12.1 min) and procedural time (89.5 ± 23.9 min vs. 111.15 ± 27.9 min) were significantly shorter in the HPSD group compared to the standard group (both P < 0.001). Conclusion High-power short-duration ablation demonstrated a comparable safety profile to conventional ablation. High-power short-duration ablation using 70 W for 5–7 s leads to significantly less arrhythmia recurrences after 1 year. Radiofrequency and procedural time were significantly shortened.

High‐power short duration and low‐power long duration in atrial fibrillation ablation: A meta‐analysis

“…This study also had the highest effect size among the three studies that demonstrated a significant association between HPSD and the increased freedom from AT. 17,18,27 The study by Kottmaier et al 17 was the only included study that used a significantly higher power of 70 W for 5-7 s and was also demonstrated significantly higher atrial arrhythmia recurrences with LPLD (32.3% vs. 14.2%, OR = 2.73, 95%…”

“…Ten studies from 2006 to 2020 involving 2274 patients were included (1393 patients underwent HPSD strategy and 881 patients underwent LPLD strategy). 10,[15][16][17][18][19][20][21][22]27 There were six in the…”

Safety and Efficacy of High Power Shorter duration Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis.

“…A significant difference in power delivery setting was found between the HPSD and LPLD groups. There is no consensus about the power and duration settings for HPSD, in our study, energy levels above 40 W are considered as high power and duration of application for 2˜10s as short duration 4,13,14,[17][18][19][20] . All patients received PVI, additional linear ablations were performed in select patients at the operator's discretion in some trials 4,18,19 .…”

Comparison of high‐power and conventional‐power radiofrequency energy deliveries in pulmonary vein isolation using unipolar signal modification as a local endpoint

“…Previous clinical studies have evaluated the HPSD ablation during the PVI procedure using several endpoints for each RF application, such as the RF time, 10‐14 CF‐related indices (ablation index 11,15‐17 and lesion size index 11,18 ), and loss of pacing capture during the RF delivery 18 . However, little is known about high‐power RF ablation for a PVI using USM as a guide for the local endpoint of each RF application 19 …”