Very high-power short duration radiofrequency ablation to achieve pulmonary vein isolation: the AIR HPSD registry

The QDOT Micro catheter allows to perform a very high-power short-duration ablation that produces wider and shallower lesions. This study aims to corroborate the evidences on the safety, acute and long-term efficacy of this catheter by providing a large real-world dataset. The AIR HPSD Registry is a multicentric prospective registry across 26 European centers that enrolled consecutive atrial fibrillation (AF) patients undergoing their first pulmonary vein (PV) isolation. In all patients a wide antrum circumferential ablation aimed at PV isolation was performed using the QDOT Micro catheter in QMode+ (90 w for 4 s) for the whole ablation or in a hybrid mode (QMode + for the posterior wall and QMode guided by ablation index for the anterior wall), according to the operators’ preference. Overall, 982 patients have been enrolled, 38% of patients were ablated with the QMode + solely and 62% with a hybrid modality. The fluoroscopy time was higher in the hybrid group (396 ± 493 s vs. 138 ± 238 s, p < 0.001) and similarly the procedural time (112 ± 41 min vs. 96 ± 36 min, p = 0.01). The complications (1.8%) were similar between groups (1.1% in Qmode+ group vs. 2.3% in hybrid group, p = 0.3). The freedom from AF/AT recurrence was similar between groups (88% hybrid group vs. 90% Qmode+ group, p = ns) and higher in paroxysmal than in persistent patients (90% vs. 81%, p < 0.001). The QDOT Micro catheter demonstrated high efficiency, safety, and effectiveness in achieving PV isolation in patients undergoing their first ablation for paroxysmal or persistent AF.