Key result
Low-index HPSD ablation is linked to ~67% higher early recurrence but similar long-term success versus conventional.
Why the study?
The study evaluated the difference in effectiveness and safety of high-power, short-duration RFA guided by relatively low ablation index values compared to conventional RFA in paroxysmal AF patients.
Does high-power, short-duration radiofrequency catheter ablation guided by relatively low ablation index values improve outcomes in patients with paroxysmal atrial fibrillation compared to conventional ablation?
Cohort (n=943)
Does high-power, short-duration radiofrequency catheter ablation guided by relatively low ablation index values improve outcomes in patients with paroxysmal atrial fibrillation compared to conventional ablation?
Absolute Event Rate: 22.727% vs 13.636%
p-value: p=0.003
High-power, short-duration ablation using relatively low ablation index values for paroxysmal atrial fibrillation results in higher early recurrence but similar long-term success and safety compared to conventional ablation.
HPSD at low AI may raise early recurrence risk without long-term benefit; leaves open optimal ablation index targets in paroxysmal AF.
Objective: The purpose of this study was to evaluate the difference in effectiveness and safety of high-power, short-duration (HPSD) radiofrequency catheter ablation (RFA) guided by relatively low ablation index (AI) values and conventional RFA in paroxysmal atrial fibrillation (PAF) patients. Methods: The HPSD RFA strategy (40–50 W, AI 350–400 for anterior, 320–350 for posterior wall; n = 547) was compared with the conventional RFA strategy (25–40 W, without AI; n = 396) in PAF patients who underwent their first ablation. Propensity-score matching analyses were used to compare the outcomes of the two groups while controlling for confounders. Results: After using propensity-score matching analysis, the HPSD group showed a higher early recurrence rate (22.727% vs. 13.636%, p = 0.003), similar late recurrence rate, and comparable safety (p = 0.604) compared with the conventional group. For late recurrent atrial arrhythmia types, the rate of regular atrial tachycardia was significantly higher in the HPSD group (p = 0.013). Additionally, the rate of chronic pulmonary vein reconnection and non-pulmonary vein triggers during repeat procedures was similar in both groups. Conclusions: For PAF patients, compared with the conventional RFA strategy, the HPSD RFA strategy at relatively low AI settings had a higher early recurrence rate, similar long-term success rate, and comparable safety.
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Jin et al. (2023) conducted a cohort in Paroxysmal atrial fibrillation (n=943). High-power, short-duration (HPSD) radiofrequency catheter ablation vs. Conventional RFA strategy (25-40 W, without AI) was evaluated on Early recurrence rate (p=0.003). High-power, short-duration ablation at low ablation index settings had a higher early recurrence rate (22.7% vs 13.6%, p=0.003) but similar long-term success compared with conventional ablation.
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