February 23, 2023EP EuropaceOpen Access

Magnetic resonance assessment of left atrial scar formation following a novel very high-power short-duration workflow for atrial fibrillation ablation

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Why the study?

Very high-power short-duration protocols have been introduced to improve lesion formation in AF ablation, but procedural data and cardiac MRI characteristics of left atrial scar formation needed evaluation.

Does very high-power short-duration (vHPSD) ablation produce durable left atrial scar and high procedural efficacy in patients undergoing index pulmonary vein isolation for atrial fibrillation?

Structured PICO

Does very high-power short-duration (vHPSD) ablation produce durable left atrial scar and high procedural efficacy in patients undergoing index pulmonary vein isolation for atrial fibrillation?

Population

60 consecutive patients undergoing index pulmonary vein isolation for atrial fibrillation

Intervention

Very high-power short-duration (vHPSD) ablation using a contact force sensing catheter with a temperature-controlled ablation mode

Outcome

Procedural data (duration, ablation time, first-pass isolation) and left atrial scar formation assessed by cardiac late gadolinium enhancement MRI at 3 monthssurrogate

Very high-power short-duration ablation for atrial fibrillation yields short procedure times and creates durable, contiguous transmural lesions as assessed by MRI.

Implication

vHPSD ablation was associated with durable PV encirclement on MRI; hypothesis-generating and requires randomized trials before practice change.

Abstract

Aims Atrial fibrillation (AF) ablation protocols using energy delivery with very high power and short duration (vHPSD) have been introduced to improve lesion formation. This study reports procedural data of vHPSD ablation in AF patients and analyses characteristics of ablation-induced left atrial (LA) scar formation from cardiac magnetic resonance imaging (MRI). Methods and results Sixty consecutive patients undergoing index pulmonary vein isolation following our institutional Q4U-AF workflow were prospectively enrolled. Ablation was conducted using a contact force sensing catheter allowing for vHPSD ablation using a temperature-controlled ablation mode. Thirty patients underwent cardiac late gadolinium enhancement MRI of the LA 3 months after ablation to assess LA scar. Mean procedural duration was 66.5 ± 14.8 min. Mean ablation time was 4.7 ± 0.9 min with a mean number of 69.9 ± 14.2 applications. First-pass isolation was achieved in 51 patients (85%) for the right pulmonary veins (RPVs), in 37 patients (61.7%) for the left pulmonary veins (LPVs), and in 34 patients (56.7%) for both pulmonary veins (PVs). Magnetic resonance imaging at 3 months post-ablation demonstrated a mean scar width of 14.4 ± 2.6 mm around RPVs and 11.9 ± 1.9 mm at LPVs (P > 0.05). Complete PV encirclement was observed in 76.7% for RPVs, in 76.7% for LPVs, and in 66.7% for both PV pairs. During a mean follow-up of 4.7 ± 1.4 months, arrhythmia recurrence was observed in 3.3% of the patients. Conclusion Pulmonary vein isolation following a novel vHPSD workflow resulted in short procedure duration and high acute and mid-term efficacy. Magnetic resonance imaging demonstrated durable and transmural PV lesions with homogeneous and contiguous scar formation.