Key result
HPSD ablation yields similar 1-year atrial arrhythmia recurrence compared to LPLD.
Why the study?
Pulmonary vein isolations are being performed using high-power, short-duration strategies, prompting a comparison of clinical efficacy and safety outcomes against a low-power, long-duration approach in paroxysmal AF.
Does high-power short-duration ablation reduce 1-year recurrence of atrial arrhythmia in patients with paroxysmal atrial fibrillation compared to low-power long-duration ablation?
Cohort (n=398)
Does high-power short-duration ablation reduce 1-year recurrence of atrial arrhythmia in patients with paroxysmal atrial fibrillation compared to low-power long-duration ablation?
A high-power short-duration ablation strategy for paroxysmal atrial fibrillation yields similar clinical efficacy to a low-power long-duration strategy but significantly reduces procedural time.
Introduction Pulmonary vein isolations (PVI) are being performed using a high‐power, short‐duration (HPSD) strategy. The purpose of this study was to compare the clinical efficacy and safety outcomes of an HPSD versus low‐power, long‐duration (LPLD) approach to PVI in patients with paroxysmal atrial fibrillation (AF). Methods Patients were grouped according to a HPSD (≥40 W) or LPLD (≤35 W) strategy. The primary endpoint was the 1‐year recurrence of any atrial arrhythmia lasting ≥30 s, detected using three 14‐day ambulatory continuous ECG monitoring. Procedural and safety endpoints were also evaluated. The primary analysis were regression models incorporating propensity scores yielding adjusted relative risk (RR a ) and mean difference (MD a ) estimates. Results Of the 398 patients included in the AWARE Trial, 173 (43%) underwent HPSD and 225 (57%) LPLD ablation. The distribution of power was 50 W in 75%, 45 W in 20%, and 40 W in 5% in the HPSD group, and 35 W with 25 W on the posterior wall in the LPLD group. The primary outcome was not statistically significant at 30.1% versus 22.2% in HPSD and LPLD groups with RR a 0.77 (95% confidence interval [CI]) 0.55–1.10; p = .165). The secondary outcome of repeat catheter ablation was not statistically significant at 6.9% and 9.8% (RR a 1.59 [95% CI 0.77–3.30]; p = .208) respectively, nor was the incidence of any ECG documented AF during the blanking period: 1.7% versus 8.0% (RR a 3.95 [95% CI 1.00–15.61; p = .049) in the HPSD versus LPLD group respectively. The total procedure time was significantly shorter in the HPSD group (MD a 97.5 min [95% CI 84.8–110.4)]; p < .0001) with no difference in adjudicated serious adverse events. Conclusions An HPSD strategy was associated with significantly shorter procedural times with similar efficacy in terms of clinical arrhythmia recurrence. Importantly, there was no signal for increased harm with a HPSD strategy.
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Joza et al. (2023) conducted a cohort in paroxysmal atrial fibrillation (AF) (n=398). High-power short-duration (HPSD) ablation vs. Low-power long-duration (LPLD) ablation (≤35 W) was evaluated on 1-year recurrence of any atrial arrhythmia lasting ≥30 s (adjusted RR 0.77, 95% CI 0.55-1.10, p=0.165). High-power short-duration ablation for pulmonary vein isolation showed similar 1-year atrial arrhythmia recurrence compared to a low-power long-duration strategy (adjusted RR 0.77; 95% CI 0.55-1.10; p=0.165).
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