Very High-Power Ablation for Contiguous Pulmonary Vein Isolation

O’Neill, Louisa; Haddad, Milad El; Berte, Benjamin; Kobza, Richard; Hilfiker, Gabriela; Scherr, Daniel; Manninger, Martin; Wijnmaalen, Adrianus P.; Trines, Serge A.; Wielandts, Jean‐Yves; Gillis, Kris; Lycke, Michelle; Becker, Benjamin De; Tavernier, René; Waroux, Jean-Benoît le Polain de; Knecht, Sébastien; Duytschaever, Mattias

doi:10.1016/j.jacep.2022.10.039

Cited by 40 publications

(50 citation statements)

References 18 publications

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“…In the present study, single-procedure freedom from ATA off ADT nears 80%, comparable to success rates in contemporary studies using intermittent Holter monitoring after PVI in paroxysmal AF patients. 15,[17][18][19] Traditionally, PersAF patients have represented a more challenging cohort, however, with more modest success rates (in the It is tempting to speculate that the high success rate observed in the present study is due to the increased likelihood of durable isolation after CLOSE-guided ablation, as demonstrated in paroxysmal AF 18,[20][21][22] and PersAF patients. 27 Caution is required, however, when comparing the efficacy of CA in PersAF patients between trials.…”

Section: Clinical Effectiveness Of Pvi-only In Persafmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

“…14 We opted for a strategy aiming to deliver stable, contiguous, and optimized radiofrequency applications encircling the veins (CLOSE). Prior work from our group together with European and US multicenter studies in paroxysmal AF has demonstrated that this strategy is associated with excellent freedom from ATA [15][16][17][18][19] and durable pulmonary vein isolation. [20][21][22] To better understand which PersAF patients may benefit from PVIonly, we prospectively collected various parameters to stage the severity of PersAF.…”

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confidence: 98%

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No Effect of Continued Antiarrhythmic Drug Treatment on Top of Optimized Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation: Results From the POWDER-AF2 Trial

Demolder,

O’Neill,

El Haddad

et al. 2023

Circ: Arrhythmia and Electrophysiology

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Background: In patients with persistent atrial fibrillation (PersAF), catheter ablation aiming for pulmonary vein isolation (PVI) is associated with moderate clinical effectiveness. We investigated the benefit of continuing previously ineffective class 1C or 3 antiarrhythmic drug therapy (ADT) in the setting of a standardized PVI-only ablation strategy. Methods: In this multicenter, randomized controlled study, patients with PersAF (≥7 days and <12 months) despite ADT were prospectively randomized 1:1 to PVI with ADT continued versus discontinued beyond the blanking period (ADT ON versus ADT OFF). Standardized catheter ablation was performed aiming for durable isolation with stable, contiguous, and optimized radio frequency applications encircling the pulmonary veins (CLOSE protocol). Clinical visits and 1-to-7-day Holter were performed at 3, 6, and 12 months. The primary end point was any documented atrial tachyarrhythmia lasting >30 seconds beyond 3 months. Prospectively defined secondary end points included repeat ablations, unscheduled arrhythmia-related visits, and quality of life among groups. Results: Of 200 PersAF patients, 98 were assigned to ADT OFF and 102 to ADT ON. The longest atrial fibrillation episode qualifying for PersAF was 28 (10–90) versus 30 (11–90) days. Clinical characteristics and procedural characteristics were similar. Recurrence of atrial tachyarrhythmia was comparable in both groups (20% OFF versus 21.2% ON). No differences were observed in repeat ablations and unscheduled arrhythmia-related visits. Marked improvement in quality of life was observed in both groups. Conclusions: In patients with PersAF, there is no benefit in continuing previously ineffective ADT beyond the blanking period after catheter ablation. The high success rate of PVI-only might be explained by the high rate of durable isolation after optimized PVI and the early stage of PersAF (POWDER-AF2). REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03437356.

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Section: Clinical Effectiveness Of Pvi-only In Persafmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

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No Effect of Continued Antiarrhythmic Drug Treatment on Top of Optimized Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation: Results From the POWDER-AF2 Trial

Demolder,

O’Neill,

El Haddad

et al. 2023

Circ: Arrhythmia and Electrophysiology

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“…10,14,18 Recently published papers show similar safety and 1-year follow-up results with 90and 25 to 50-W energy settings. 11,14,[18][19][20] Although AF recurrence is a gold-standard measure of the efficacy of PVI, it is still not the most objective end point of procedural success, as there is not a one-to-one relationship between PV reconnection and AF recurrence. Invasive repeat LA mapping is considered the most accurate way to evaluate the durability of PVI and, thus, to validate a given technique's efficacy for PVI.…”

Section: Vhpsd Pvimentioning

confidence: 99%

Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study

Szegedi,

Salló,

Nagy

et al. 2024

Circ: Arrhythmia and Electrophysiology

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BACKGROUND: High-power short-duration ablation has shown impressive efficacy and safety for pulmonary vein isolation (PVI); however, initial efficacy results with very high power short-duration ablation were discouraging. This study compared the long-term durability of PVI performed with a 90 versus 50 W power setting. METHODS: Patients were randomized 1:1 to undergo PVI with the QDOT catheter using a power setting of 90 or 50 W. Three months after the index procedure, patients underwent a repeat electrophysiology study to identify pulmonary vein reconnections. Patients were followed for 12 months to detect AF recurrences. RESULTS: We included 46 patients (mean age, 64 years; female, 48%). Procedure (76 versus 84 minutes; P =0.02), left atrial dwell (63 versus 71 minutes; P =0.01), and radiofrequency (303 versus 1040 seconds; P <0.0001) times were shorter with 90W versus 50W procedures, while the number of radiofrequency applications was higher with 90W versus 50W (77 versus 67; P =0.01). There was no difference in first-pass isolation (83% versus 82%; P =1.0) or acute reconnection (4% versus 14%; P =0.3) rates between 90W and 50W. Forty patients underwent a repeat electrophysiology study. Durable PVI on a per PV basis was present in 72/78 (92%) versus 68/77 (88%) PVs in the 90W and 50W energy setting groups, respectively; effect size: 72/78−68/77=0.040, lower 95% CI=−0.051 (noninferiority limit=−0.1, ie, noninferiority is met). No complications occurred. There was no difference in 12-month atrial fibrillation-free survival between the 90W and 50W groups ( P =0.2). CONCLUSIONS: Similarly high rates of durable PVI and arrhythmia-free survival were achieved with 90W and 50W. Procedure, left atrial dwell, and radiofrequency times were shorter with 90W compared with 50W. The sample size is too small to conclude the safety and long-term efficacy of the high and very high-power short-duration PVI; further studies are needed to address this topic. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05459831.

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“…However, no differences in 6‐month outcomes were observed. The authors suggest to test a hybrid approach combining QMODE+ for anterior and QMODE for posterior aspects of the LA in future studies 33 …”

Section: Pulmonary Vein Isolation Utilizing the Qdot Micro™ Cathetermentioning

confidence: 99%

Very high‐power short‐duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series

Heeger,

Kuck,

Tilz

2023

Cardiovasc electrophysiol

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The QDOT MICRO™ Catheter is a novel open‐irrigated contact force‐sensing radiofrequency ablation catheter. It offers very high‐power short‐duration (vHPSD) ablation with 90 W for 4 s to improve safety and efficacy of catheter ablation procedures. Although the QDOT MICRO™ Catheter was mainly designed for pulmonary vein isolation (PVI) its versatility to treat atrial fibrillation (AF) and other types of arrhythmias was recently evaluated by the FAST and FURIOUS study series and other studies and will be presented in this article. Available study and registry data as well as case reports concerning utilization of the QDOT MICRO™ Catheter for the treatment of cardiac arrhythmias including AF, focal and macroreentry atrial tachycardia, typical atrial flutter by cavotricuspid isthmus block, premature ventricular contractions, and accessory pathways were reviewed and summarized. In summary, the QDOT MICRO™ Catheter showed safety and efficacy for PVI and is able to treat also other types of arrhythmias as is was recently evaluated by case reports and the FAST and FURIOUS studies.

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Very High-Power Ablation for Contiguous Pulmonary Vein Isolation

Cited by 40 publications

References 18 publications

No Effect of Continued Antiarrhythmic Drug Treatment on Top of Optimized Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation: Results From the POWDER-AF2 Trial

No Effect of Continued Antiarrhythmic Drug Treatment on Top of Optimized Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation: Results From the POWDER-AF2 Trial

Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study

Very high‐power short‐duration catheter ablation for treatment of cardiac arrhythmias: Insights from the FAST and FURIOUS study series

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