Key result
Very high-power short-duration ablation fails to reduce acute pulmonary vein reconnections versus standard ablation.
Why the study?
Very high-power short-duration (vHPSD) was developed to optimize radiofrequency ablation for atrial fibrillation, but data on vHPSD >= 70W remain limited.
Does very high-power short-duration (70 W/5-7 s) radiofrequency ablation reduce the number of acutely reconnected pulmonary veins compared to standard ablation in patients with paroxysmal atrial fibrillation?
RCT (n=200)
Open-label with blinded outcome assessment
1:1 permuted-block randomization
No
Does very high-power short-duration (70 W/5-7 s) radiofrequency ablation reduce the number of acutely reconnected pulmonary veins compared to standard ablation in patients with paroxysmal atrial fibrillation?
Absolute Event Rate: 0.6% vs 0.8%
p-value: p=0.145
Very high-power short-duration (70W) ablation is non-superior to standard ablation for acute pulmonary vein reconnection, but significantly reduces procedure time and atrial tachycardia recurrences.
Does not support 70 W/5-7 s ablation to minimize acute reconnections; challenges assumptions of superior lesion durability versus standard protocols.
AIMS: Very high-power short-duration (vHPSD) was developed to optimize radiofrequency ablation for atrial fibrillation (AF). However, data on vHPSD ≥ 70W remains limited. We investigated acute efficacy, safety and long-term rhythm outcomes of vHPSD-70W in a randomized controlled trial. METHODS AND RESULTS: A total of n = 200 patients with paroxysmal AF were randomly assigned 1:1 to receive pulmonary vein isolation (PVI) using vHPSD (70 W/5-7 s) or standard (30-40W, 20-40 s) ablation with a flexible, enhanced-irrigation tip catheter. Primary endpoint was the number of reconnected pulmonary veins (rPV) after adenosine testing. Secondary endpoints included first-pass isolation (FPI), silent cerebral lesions (SCLs) and rhythm outcomes on 12-month follow-up. Mean number of rPVs was 0.6 ± 0.8 vs. 0.8 ± 0.9 (P = 0.145) with vHPSD-70W vs. standard ablation. Bilateral FPI was 42.7% vs. 30.2% (P = 0.072), while FPI of left PVs was higher with vHPSD-70W (63.5% vs. 49.0%, P = 0.042). Procedure (107.7 ± 34.2 vs. 131.3 ± 42.2 min) and radiofrequency (15.1 ± 6.7 vs. 41.8 ± 18.3 min) duration were significantly lower with vHPSD-70W (P < 0.001). Silent cerebral lesions occurred in 1/25 (4.0%) vs. 3/22 (13.6%, P = 0.328). On 12-month follow-up, freedom from any atrial arrhythmia (76.0% vs. 66.7%, P = 0.171) was similar, while vHPSD-70W showed a lower incidence of atrial tachycardia (AT) recurrence (1.0% vs. 10.4%, P = 0.005). CONCLUSION: Very high-power short-duration with 70 W/5-7 s was non-superior to standard ablation regarding acute PV reconnection and 12-month freedom from any atrial arrhythmia. However, vHPSD-70W achieved a higher FPI rate of left PVs with a shorter procedure duration and a comparable safety profile. AT recurrence was significantly less common with vHPSD-70W.
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Popa et al. (2025) conducted an RCT in Paroxysmal atrial fibrillation (n=200). Very high-power short-duration (vHPSD) ablation vs. Standard ablation (30-40 W/20-40 s) was evaluated on Number of reconnected pulmonary veins after adenosine testing (p=0.145). Very high-power short-duration ablation with 70 W/5-7 s was non-superior to standard ablation regarding the mean number of acutely reconnected pulmonary veins (0.6 vs. 0.8, P=0.145).
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