Direct comparison of two 50 W high power short duration approaches—Temperature‐ versus ablation index‐guided radiofrequency ablation for atrial fibrillation

Introduction Approaches applying higher energy levels for shorter periods (high power short duration, HPSD) to improve lesion formation for atrial fibrillation (AF) ablation have been introduced. This single‐center study aimed to compare the efficacy, safety, and lesion formation using the novel DiamondTemp (DT) catheter or an ablation index (AI)‐guided HPSD ablation protocol using a force‐sensing catheter with surround‐flow irrigation. Methods One hundred thirteen consecutive patients undergoing radiofrequency‐guided catheter ablation (RFCA) for AF were included. Forty‐five patients treated with the DT catheter (50 W, 9 s), were compared to 68 consecutive patients undergoing AI‐guided ablation (AI anterior 550; AI posterior 400) adherent to a 50 W HPSD protocol. Procedural data and AF recurrence were evaluated. Results Acute procedural success was achieved in all patients ( n = 113, 100%). DT‐guided AF ablation was associated with a longer mean procedure duration (99.10 ± 28.30 min vs. 78.24 ± 25.55, p < .001) and more RF applications (75.24 ± 30.76 min vs. 61.27 ± 14.06, p = .019). RF duration (792.13 ± 311.23 s vs. 1035.54 ± 287.24 s, p < .001) and fluoroscopy dose (183.81 ± 178.13 vs. 295.80 ± 247.54 yGym 2 , p = .013) were lower in the DT group. AI‐guided HPSD was associated with a higher AF‐free survival rate without reaching statistical significance ( p = .088). Especially patients with PERS AF ( p = .009) as well as patients with additional atrial arrhythmia substrate ( p = .002) benefited from an AI‐guided ablation strategy. Conclusion Temperature‐ and AI‐ controlled HPSD RFCA using 50 W was safe and effective. AI‐guided HPSD ablation seems to be associated with shorter procedure durations and fewer RF applications. Particularly in advanced AF, freedom from AF‐recurrence may be improved using an AI‐guided HPSD approach.