What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic typical atrial flutter (n=100). Intervention: Very high-power short-duration (vHPSD) radiofrequency ablation vs. Ablation-index (AI) guided ablation. Primary outcome: Recurrence of atrial flutter after 12 months (p=1).

What does this research mean for the field?

Very high-power short-duration ablation significantly reduces median radiofrequency time compared to ablation-index guided ablation for cavotricuspid isthmus block, while maintaining similar safety and 12-month recurrence rates. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 20, 2026Journal of Interventional Cardiac Electrophysiology0 citationsOpen Access

Comparison of very high-power short-duration and ablation index guided catheter ablation for cavotricuspid isthmus block

Q: What question did this study set out to answer?

This study aims to compare the safety and effectiveness of very high-power short-duration and ablation index-guided catheter ablation for cavotricuspid isthmus block in atrial flutter patients.

BKBettina KirsteinElectrophysiology MBMartin Benedikt CECharlotte Eitel

Key Result

Very high-power short-duration ablation significantly reduced median radiofrequency time compared to ablation-index guided ablation (142 s vs 574 s, p<0.001) with similar 12-month recurrence.

Key Points

This study aims to compare the safety and effectiveness of very high-power short-duration and ablation index-guided catheter ablation for cavotricuspid isthmus block in atrial flutter patients.
Single-center observational cohort study
Included 100 patients undergoing CTI ablation
Compared 50 patients treated with vHPSD (90 W/4 s) to 50 patients treated with AI-guided ablation
Collected median RF applications and duration for both groups
Monitored periprocedural complications and AFL recurrence rates
All patients achieved successful CTI block using both methods
vHPSD group had significantly fewer median RF applications and times than the AI group (p < 0.001)
No significant differences in periprocedural complications between groups
Recurrence of AFL at 12 months was low and similar in both groups (2% vs. 2%, p = 1)
Durability of CTI block during re-ablation showed no significant difference (75% vHPSD vs. 67% AI, p = 0.809)

Study Design

Type

Cohort (n=100)

Multicenter

Structured PICO

Does very high-power short-duration (vHPSD) ablation reduce radiofrequency time and maintain efficacy compared to ablation-index guided ablation in patients with typical atrial flutter?

Population

100 consecutive adult patients undergoing cavotricuspid isthmus (CTI) ablation for symptomatic typical atrial flutter (AFL), mean age 72, 29% female, Germany-based. Key inclusion: documented symptomatic typical AFL scheduled for CTI ablation. Key exclusion: prior CTI or right atrial ablation, prior PVI or left atrial ablation, congenital heart disease, predominant atypical flutter, severe valvular heart disease.

Intervention

Very high-power short-duration (vHPSD) temperature-controlled radiofrequency (RF) ablation using 90 watts over 4 seconds per lesion with a minimum contact force of 15-20 g.

Comparator

Conventional contact-force (CF) ablation-index (AI) guided ablation targeting AI values of 450-500 using 30-40 W of RF energy with a minimum contact force of 5 g.

Outcome

Acute procedural success, defined as achievement of bidirectional cavotricuspid isthmus (CTI) block.surrogate

Very high-power short-duration (90 W/4 s) ablation for typical atrial flutter significantly reduces radiofrequency application time compared to ablation-index guided ablation while maintaining similar acute success, safety, and 12-month rhythm outcomes.

Main Result

Absolute Event Rate: 2% vs 2%

p-value: p=1

Abstract

Catheter ablation for the treatment of typical atrial flutter (AFL) provides effective and durable cavotricuspid isthmus (CTI) block associated with encouraging clinical outcome. Safety and efficacy of very high-power short-duration (vHPSD) temperature-controlled radiofrequency (RF) CTI ablation with 90 watts over 4 s (90 W/4 s) for typical AFL in comparison to conventional contact-force (CF) ablation-index (AI) guided ablation remains insufficiently investigated. This single-center observational cohort study based on prospectively collected registry data included 100 consecutive patients undergoing CTI ablation for symptomatic typical AFL, with 50 patients treated using a vHPSD strategy (vHPSD-group) and 50 patients using an AI-guided ablation approach (AI-group). All CTIs were successfully blocked using either method. Median RF applications and RF times in the vHPSD-group and AI-group were 36 IQR 26;47 versus 18 IQR 12;26, p < 0.001 and 142 s IQR 105;189 s versus 574 s IQR 401;983, p < 0.001, respectively. No differences in periprocedural complications were observed. Recurrence of AFL after 12 months was low with no significant differences between groups (2% vs. 2%, p = 1). In patients with re-ablation there was no difference in CTI block durability between both groups (75% vHPSD-group versus 67% AI-group, p = 0.809). Very HPSD ablation (90 W/4 s) is a safe and effective strategy for CTI ablation, offering the advantage of markedly shorter CTI RF application times compared with AI-guided ablation. Rates of periprocedural complications, acute and durable CTI block, and long-term arrhythmia recurrence are similar between the two approaches. We compared very high-power short-duration (vHPSD, 90 W/4 s) versus ablation-index-guided cavotricuspid isthmus (CTI) ablation in typical atrial flutter. Acute bidirectional CTI block was achieved in all patients. vHPSD significantly reduced CTI radiofrequency time without increased complications and showed similarly low recurrence and CTI block durability at 12 months.

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