Key result
Ablation using 90W vHPSD achieved higher right-sided first-pass isolation rates compared with 50W ablation (97.1% vs. 89.3%; p=0.031) and significantly shorter procedure times.
Why the study?
Very high-power, short-duration RFA was developed to improve procedural efficiency and durable lesions, but the incidence and predictors of first-pass pulmonary vein isolation comparing 90W and 50W protocols needed assessment.
Does 90W very high-power short-duration radiofrequency ablation improve first-pass pulmonary vein isolation rates and procedural efficiency compared to 50W ablation in patients undergoing AF ablation?
Cohort (n=180)
Does 90W very high-power short-duration radiofrequency ablation improve first-pass pulmonary vein isolation rates and procedural efficiency compared to 50W ablation in patients undergoing AF ablation?
Odds Ratio: 0.23
Absolute Event Rate: 97.1% vs 89.3%
p-value: p=0.031
Very high-power short-duration (90W) radiofrequency ablation significantly reduces procedure time and improves right-sided first-pass pulmonary vein isolation compared to 50W ablation.
Introduction First-pass pulmonary vein isolation (FPI) is an important quality marker of atrial fibrillation (AF) ablation, reflecting lesion efficacy and continuity. Very high-power, short-duration (vHPSD) radiofrequency ablation (RFA) has been developed to enhance procedural efficiency while maintaining durable lesion formation. This study aimed to assess the incidence and predictors of left- and right-sided FPI during 90W (vHPSD) and 50W (HPSD) RFA. Methods In this prospective study, 180 patients undergoing point-by-point pulmonary vein isolation were included and stratified by applied power (90W vs. 50W). Clinical and procedural parameters were analyzed to identify predictors of FPI using univariate and multivariate logistic regression models. Results Procedural duration was significantly shorter with 90W compared to 50W (38.7±8.7 min vs. 58.9±15.6 min; p≤0.001). The time intervals from vascular access to mapping, mapping to ablation, and ablation to validation were all shorter with 90W (p≤0.001). Left-sided FPI rates were similar between groups (93.3% vs. 93.3%; p = 1.00), while right-sided FPI was more frequent with 90W (97.1% vs. 89.3%; p=0.031). On univariate analysis, longer procedural duration was a negative predictor of left-sided FPI (OR=0.95; p=0.003). For right-sided FPI, in multivariate analysis, the use of 50W power was an independent negative predictor (OR=0.23; p=0.04). Conclusion Ablation using 90W vHPSD RFA achieved shorter procedure times and higher right-sided FPI rates compared with 50W ablation. Procedural duration and applied power level were independent predictors of successful first-pass isolation.
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Debreceni et al. (2026) conducted a cohort in Atrial fibrillation (n=180). 90W very high-power short-duration (vHPSD) radiofrequency ablation vs. 50W (HPSD) radiofrequency ablation was evaluated on Right-sided first-pass pulmonary vein isolation (FPI) (OR 0.23, p=0.031). Ablation using 90W vHPSD achieved higher right-sided first-pass isolation rates compared with 50W ablation (97.1% vs. 89.3%; p=0.031) and significantly shorter procedure times.
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