vHPSD ablation reduced procedure time (57.7 vs 72.4 min) and RF time (8.3 vs 37.1 min) but had lower first-pass isolation and higher PV reconnection rates vs AI-guided PVI.
Does very high-power short-duration ablation improve procedural characteristics compared to conventional ablation-index guided ablation in patients with atrial fibrillation undergoing pulmonary vein isolation?
Very high-power short-duration ablation significantly reduces procedure and radiofrequency times compared to conventional ablation-index guided ablation, but may result in lower first pass isolation and higher acute reconnection rates.
Abstract Background Very high-power short-duration (vHPSD) radiofrequency (RF) ablation may reduce procedure time compared to conventional ablation-index (AI) guided pulmonary vein isolation (PVI) while ensuring continuous, transmural lesions. Purpose To study the effect of vHPSD ablation on PVI procedural characteristics compared to conventional AI-guided ablation. Methods A total of 86 patients with paroxysmal or persistent AF referred for primary RF PVI were included. The AI group (n=45), from the OPTIGRID Study (2018-2019), underwent PVI using a SmartTouch catheter at 40/30W and inter tag distance (ITD) 6 mm. The vHPSD group (n=41), from the Q-POWER Study (2023-2024), underwent PVI with the QDOT MICRO™ catheter using 90W/4s and ITD 4 mm and partly 6 mm for the posterior wall. Touch-up ablation was performed using ≤50W. In both groups, PVI was confirmed by conduction block during a waiting period of 30 min. If reconnection occurred, further ablation was performed until re-isolation. Results Baseline characteristics were similar, except for a younger age in the vHPSD group (61±8 vs. 70±7 years, p0.001). Procedure and RF times were significantly lower using vHPSD compared to AI-guided PVI (57.7±29.4 vs. 72.4±25.9min, p=0.02; 8.3±3.0 vs. 37.1±7.6min, p0.001, respectively). Trends were observed in lower first pass isolation (FPI) rates of the right PVs in the vHPSD group (43.9% vs. 62.2%, p=0.09), as well as higher reconnection rates of both left and right PVs compared to the AI group (34.1% vs. 15.9%, p=0.05; 29.3% vs. 13.6%, p=0.08, respectively). Conclusion Although PVI using solely vHPSD ablation results in reduced procedure and RF times, it showed lower rate of FPI and higher reconnection rates compared to conventional AI-guided ablation. This may question the ability of vHPSD to achieve transmural lesions in all PV segments. Long-term follow-up is needed to determine durability of PVI and differences in AF recurrence with both ablation techniques.
Pouderoijen et al. (2025) studied this question. vHPSD ablation reduced procedure time (57.7 vs 72.4 min) and RF time (8.3 vs 37.1 min) but had lower first-pass isolation and higher PV reconnection rates vs AI-guided PVI.