Very high-power short-duration ablation for pulmonary vein isolation utilizing a very-close protocol—the FAST AND FURIOUS PVI study

Figures

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  Figure 1. QDOT micro catheter in QMODE± utilizing the very-close protocol: A–F: posterior aspect: three-dimensional electroanatomic reconstruction (CARTO 3, UNIVIEW module, Biosense Webster) of the left atrium in right anterior oblique (left) and right lateral (right) view. Please note the deployment of very high-power short-duration applications by 90W/4 s. At the posterior area an ILD of 5–6 mm was targeted. G–L: anterior aspect: Three-dimensional electroanatomic reconstruction (CARTO 3, UNIVIEW module, Biosense Webster) of the left atrium in posterior anterior (left) and left lateral (right) view. Please note the deployment of very-high power short duration applications by 90 W/4 s (QMODE+ mode, red–white tags) at the anterior aspect of the left pulmonary veins. At the anterior area an ILD of 3–4 mm was targeted.

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  Figure 2. Final lesions set. Three-dimensional electroanatomic reconstruction (CARTO 3, UNIVIEW module, Biosense Webster) of the left atrium in posterior anterior (left) and anterior posterior (right) view. Please note the two circles of very-high power short duration applications by 90 W/4 s (QMODE+ mode, red–white tags) encircling the right and left pulmonary veins.

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  Figure 3. Periprocedural data: periprocedural duration: (A) procedure time; (B) left atrial dwelling time; (C) total radiofrequency time, vHP-SD group compared with the control group.

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  Figure 4. 12-month follow-up and findings of repeat procedures. (A) Kaplan–Meier estimates with 12-month follow-up after the index PVI utilizing very-high power short duration applications by 90 W/4 s (QMODE+) only and the control group. No statistical differences were found concerning 12-month freedom from atrial tachyarrhythmias. (B) Comparison of pulmonary vein durability assessed during repeat procedures of n = 7 (very high-power short-duration group) and n = 9 (control) patients. All four PVs were found to be isolated in 57% of very high-power short-duration group and 0% of control group patients.