Safety and efficacy of intracardiac echocardiography-guided zero-fluoroscopy ablation in atrial fibrillation patients: a comparative study of high-power short-duration and low-power long-duration strategies

Guang-An Liu; Bo Shao; Weihua Wu; Lingxiao Zhou; Jing Cui; Wenxue Chen; Ruoxi Zhang; Feng Liu

doi:10.3389/fcvm.2024.1510889

November 21, 2024Frontiers in Cardiovascular MedicineOpen Access

Safety and efficacy of intracardiac echocardiography-guided zero-fluoroscopy ablation in atrial fibrillation patients: a comparative study of high-power short-duration and low-power long-duration strategies

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Why the study?

Comprehensive clinical data were lacking on the safety and effectiveness of high-power short-duration ablation combined with intracardiac echocardiography-guided zero-fluoroscopy procedures in atrial fibrillation.

Does high-power short-duration ablation improve efficacy or safety compared to low-power long-duration ablation in AF patients undergoing ICE-guided zero-fluoroscopy ablation?

Key Points

To compare the safety and clinical efficacy of high-power short-duration versus low-power long-duration ablation strategies during intracardiac echocardiography-guided zero-fluoroscopy procedures in patients with atrial fibrillation.
Retrospective analysis of 173 consecutive patients with atrial fibrillation undergoing zero-fluoroscopy catheter ablation.
Interventions used electroanatomic mapping and intracardiac echocardiography guidance to deliver either high-power short-duration (HPSD) or low-power long-duration (LPLD) radiofrequency ablation for pulmonary vein isolation.
Treatment efficacy, total procedure and ablation durations, and perioperative complication rates were evaluated through one year of follow-up.
All 173 procedures were completed entirely without fluoroscopy, with significantly shorter total procedure and ablation times observed in the HPSD group compared to the LPLD group.
At one-year follow-up, sinus rhythm maintenance was documented in 77 patients in the HPSD cohort versus 74 patients in the LPLD cohort, showing no statistically significant difference.
Postoperative complications occurred in 5 patients in the HPSD group and 3 patients in the LPLD group, with 0 major adverse cardiac and cerebrovascular events reported across either cohort.

Structured PICO

Does high-power short-duration ablation improve efficacy or safety compared to low-power long-duration ablation in AF patients undergoing ICE-guided zero-fluoroscopy ablation?

P

Population

173 consecutive patients with atrial fibrillation (AF) undergoing intracardiac echocardiography (ICE)-guided zero-fluoroscopy ablation

I

Intervention

High-power short-duration (HPSD) ablation strategy using an electroanatomic mapping (EAM) system with ICE guidance

C

Comparator

Low-power long-duration (LPLD) ablation strategy using an EAM system with ICE guidance

O

Outcome

Treatment outcomes (maintenance of sinus rhythm) and incidence of complications at one-year follow-up

HPSD ablation is as effective and safe as LPLD ablation for ICE-guided zero-fluoroscopy AF ablation, while significantly reducing procedure and ablation times.

Implication

May shorten procedures with comparable outcomes in observational data; leaves open randomized confirmation for zero-fluoroscopy AF ablation.

Abstract

Introduction: In atrial fibrillation (AF) ablation, fluoroscopy has been a standard tool for catheter guidance. However, the combination of electroanatomic mapping systems (EAMs) and intracardiac echocardiography (ICE) now allows for minimal or zero-fluoroscopy procedures. Concurrently, high-power short-duration (HPSD) ablation has emerged as a promising technique, offering enhanced resistive heating while reducing conductive heating. This approach potentially improves both safety and efficacy. Despite these advancements, there is a lack of comprehensive clinical data on the safety and effectiveness of HPSD ablation when used in conjunction with ICE-guided zero-fluoroscopy procedures. Objective: To compare two different ablation strategies-high-power short-duration (HPSD) and low-power long-duration (LPLD)-both utilizing intracardiac echocardiography (ICE)-guided zero-fluoroscopy in the context of atrial fibrillation (AF) ablation. Methods: This retrospective study included 173 consecutive patients with AF who underwent ICE-guided zero-fluoroscopy ablation. Patients were divided into two groups: HPSD and LPLD. All procedures were conducted using an EAM system with ICE guidance. Both groups underwent routine pulmonary vein isolation (PVI), with additional linear ablations performed for persistent AF when necessary. We compared treatment outcomes and the incidence of complications between the two groups. Results: All procedures were successfully completed under ICE-guided zero-fluoroscopy, establishing a feasible and reliable workflow. The procedure and ablation times were significantly shorter in the HPSD group compared to the LPLD group. At one-year follow-up, sinus rhythm was maintained in 77 patients in the HPSD group and 74 patients in the LPLD group, with no significant difference between the two group. Postoperative complications occurred in 5 patients in the HPSD group and 3 patients in the LPLD group. Importantly, there were no major adverse cardiac and cerebrovascular events (MACCE) in either group. Conclusion: A zero-fluoroscopy workflow utilizing an EAM system combined with ICE appears to be both feasible and safe for ablation in AF patients. In patients undergoing ICE-guided zero-fluoroscopy ablation, the HPSD strategy is comparable to LPLD ablation in effectiveness while offering the benefit of shorter procedure and ablation times.