Clinical and procedural outcomes of very high-power short-duration vs. standard power ablation for pulmonary vein isolation

Q: What are the key findings of this study?

Very high-power short-duration ablation achieved similar freedom from atrial fibrillation recurrence at 12 months compared to standard-power ablation (83.7% vs. 86.1%, HR 1.05, p=0.848).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Atrial Fibrillation (n=226). Intervention: Very high-power short-duration (vHPSD) radiofrequency ablation vs. Standard-power atrial fibrillation ablation. Primary outcome: Freedom from atrial fibrillation recurrence at 12 months (HR 1.05, p=0.848).

Q: What does this research mean for the field?

Very high-power short-duration radiofrequency ablation achieves similar 12-month freedom from atrial fibrillation recurrence and safety compared to standard-power ablation, but with significantly reduced procedural time. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

I N E S Rodrigues; João Almeida; Rafael Teixeira; Tiago Martins; Mafalda Carrington; Helena Gonçalves; João Primo; Marco Oliveira; Paulo Fonseca; R Fontes-Carvalho

doi:10.3389/fcvm.2026.1806509

April 21, 2026Frontiers in Cardiovascular MedicineOpen Access

Clinical and procedural outcomes of very high-power short-duration vs. standard power ablation for pulmonary vein isolation

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Key result

Very high-power short-duration ablation yields similar 12-month freedom from AF recurrence compared to standard-power ablation.

HR 1.05
P=0.848
n=226

Figures

Why the study?

The study aimed to compare very high-power short-duration with standard-power atrial fibrillation ablation regarding clinical outcomes, procedural efficiency, and safety.

Does very high-power short-duration ablation improve freedom from atrial fibrillation recurrence and procedural efficiency compared to standard-power ablation in patients undergoing pulmonary vein isolation?

Study Design

Type

Observational (n=226)

Multicenter

No

Structured PICO

Does very high-power short-duration ablation improve freedom from atrial fibrillation recurrence and procedural efficiency compared to standard-power ablation in patients undergoing pulmonary vein isolation?

P

Population

226 propensity-score matched adults with paroxysmal or persistent atrial fibrillation undergoing first pulmonary vein isolation, followed for a median of up to 24 months.

E

Exposure

Very high-power short-duration (vHPSD) atrial fibrillation ablation using 90-Watt, 4-second radiofrequency applications (except anterior region using 50-watt) via QDOT Micro catheter and deflectable sheath.

C

Comparator

Standard-power atrial fibrillation ablation using 35-watt radiofrequency applications via Thermocool SmartTouch SF Catheter and a fixed curved sheath.

O

Outcome

Freedom from atrial fibrillation recurrence (any ECG-documented atrial tachyarrhythmia lasting at least 30 seconds) at 12 months.hard clinical

Main Result

Hazard Ratio: 1.05

Absolute Event Rate: 83.7% vs 86.1%

p-value: p=0.848

Very high-power short-duration ablation for atrial fibrillation significantly reduces procedural time while achieving clinical efficacy and safety profiles comparable to standard-power ablation.

Limitations

Retrospective, non-randomized design inherently limits causal inference
Inclusion of cohorts from different time periods may introduce time-period bias
Use of different sheath types (deflectable vs. fixed) between groups may represent a potential confounding factor
AF recurrence was assessed through intermittent monitoring, which may have underestimated the true arrhythmia burden
Single-center nature of the study and relatively young, healthy cohort may limit generalizability
Use of different sheath types (deflectable vs. fixed) between groups may represent a confounding factor
AF recurrence was assessed through intermittent monitoring, potentially underestimating true arrhythmia burden
Single-center nature and relatively young, healthy cohort limit generalizability

Implication

May shorten procedures with comparable 12-month AF freedom; leaves open need for randomized confirmation.

Abstract

Introduction Pulmonary vein isolation (PVI) using shorter but higher-power radiofrequency (RF) applications can improve lesion quality and reduce procedural time compared to the standard approach, while ensuring similar clinical and safety outcomes. The aim of this study was to compare very high-power short-duration (vHPSD) with standard-power atrial fibrillation (AF) ablation regarding clinical outcomes, procedural efficiency and safety. Methods All patients who underwent first PVI using RF energy between January 2021 and June 2024 were included. The two groups (standard-power vs. vHPSD AF ablation) were matched using a propensity score analysis and compared at 12 months regarding freedom from AF recurrence, quality of life improvement and safety. Results 333 patients were submitted to PVI, and after the propensity score analysis, 226 patients were analysed (65.0% male, median age 62.8 years, comparable baseline characteristics). The median follow-up time was 554 days (IQR 351, 729) for the vHPSD group and 728 days (IQR 555, 730) for the standard group ( p < 0.01). Freedom from AF recurrence at 12 months was similar between groups (83.7% vs. 86.1%, p = 0.85) and both groups exhibited significant and similar improvements in QoL measurements, following the procedure (mean adjusted difference of +13.9, 95% CI 10.4-17.5, p < 0.001). Total procedural time was significantly shorter in the vHPSD arm (86.5 min vs. 100.0 min, p < 0.01) and PV first-pass isolation (FPI) was significantly lower in the vHPSD group (52.3% vs. 72.3%, p < 0.01). AF catheter ablation had a favourable safety profile, with a low prevalence of adverse effects, irrespective of the type of RF energy used. Conclusion VHPSD AF ablation was a more efficient technique with a shorter procedural time, achieving similar clinical outcomes despite having a lower FPI rate. Both techniques appeared to be safe with low prevalence of adverse effects.

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Cite This Study

Rodrigues et al. (2026) conducted an observational in Atrial Fibrillation (n=226). Very high-power short-duration (vHPSD) radiofrequency ablation vs. Standard-power atrial fibrillation ablation was evaluated on Freedom from atrial fibrillation recurrence at 12 months (HR 1.05, p=0.848). Very high-power short-duration ablation achieved similar freedom from atrial fibrillation recurrence at 12 months compared to standard-power ablation (83.7% vs. 86.1%, HR 1.05, p=0.848).

synapsesocial.com/papers/6a09194115fb758097d25535 https://doi.org/10.3389/fcvm.2026.1806509