Feasibility of Hybriding Very High‐Power Short‐Duration and Ablation Index‐Guided Pulmonary Vein Isolation

Figures

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  FIGURE 1. Pulmonary vein isolation strategy using Ablation Index and very high‐power and short‐duration approach. (A) Group 1 (Conventional AI‐Guided PVI): Ablation was performed with a power setting of 40 W, targeting an AI of 350 for the posterior wall, bottom, and roof, and 450 for the anterior wall. Group 2 (Hybrid AI‐Guided and vHPSD PVI): Ablation of the posterior inferior wall was performed using a 90 W power setting for 4 s in temperature‐controlled mode. The remaining regions were ablated at 50 W, with the same AI targets as in Group 1. AI, Ablation Index; AP anterior posterior view; PA, posterior anterior view; PVI, pulmonary vein isolation; RF, radiofrequency; vHPSD, very high‐power short‐duration. (B) Representative case of a hybrid AI‐guided and vHPSD PVI, demonstrating contiguous RF lesions with a lesion tag diameter of 4 mm and an interlesion distance of < 4 mm.

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  FIGURE 2. Comparison of procedural parameters between the two groups. (A) First pass isolation rates were comparable between the groups (98% vs. 96%, p = 0.65 for the left PVs; 88% vs. 93%, p = 0.29 for the right PVs). (B) Acute reconnection rates showed no significant difference for both the left PVs (6% vs. 3%, p = 0.24) and the right PVs (6% vs. 3%, p = 0.24). (C) The time required to achieve PVI was significantly shorter in Group 2 for both the left PVs (16 ± 6 vs. 14 ± 7 min, p = 0.013) and the right PVs (19 ± 6 vs. 14 ± 6 min, p = 0.001). (D) Group 2 required fewer RF applications for the right PVs compared to Group 1 (49 ± 13 vs. 43 ± 14, p = 0.006). (E) The RF energy application duration per lesion was significantly shorter in Group 2 for both the left PVs (24 ± 4 vs. 21 ± 4 s, p < 0.001) and the right PVs (24 ± 4 vs. 20 ± 4 s, p < 0.001). PV, pulmonary vein; PVI, pulmonary vein isolation; RF, radiofrequency.

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  FIGURE 3. Distribution of conduction gaps and sites of reconnection in both groups. Schematic representation of the distribution of conduction gaps and reconnection sites following PVI. Panel A shows the locations in Group 1 (conventional Ablation Index‐guided PVI), and Panel B shows those in Group 2 (hybrid PVI using AI‐guided and vHPSD ablation). Blue dots indicate conduction gaps identified after first‐pass isolation, and red dots represent sites of reconnection observed during the procedure. The carina region and anatomical orientation (septum, posterior wall, anterior wall) are labeled for reference. Notably, conduction gaps were frequently observed in the carina region in both groups.

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  FIGURE 4. AF/AT recurrence during long‐term follow‐up. At 12 months of follow‐up, 133 out of 160 patients (17%) were free from AF/AT recurrence, including 67 patients in Group 1 (84%) and 66 patients in Group 2 (83%). Freedom from AF recurrence was comparable between the two groups, with no statistically significant difference (log‐rank p = 0.78; HR: 0.90; 95% CI: 0.54–2.29). AF, atrial fibrillation; AT, atrial tachycardia.