Key result
Very high-power short-duration ablation significantly increased the probability of bilateral first-pass isolation compared to low-power long-duration ablation (OR 2.90).
Why the study?
HPSD RF ablation has been proposed for rapid and effective PVI, but its procedural characteristics and first-pass isolation rates compared with vHPSD and LPLD ablation needed evaluation.
Does high-power and very high-power short-duration radiofrequency ablation improve procedural characteristics and first-pass isolation rates in patients with atrial fibrillation compared to low-power long-duration ablation?
Cohort (n=156)
Single-blind
No
Does high-power and very high-power short-duration radiofrequency ablation improve procedural characteristics and first-pass isolation rates in patients with atrial fibrillation compared to low-power long-duration ablation?
Odds Ratio: 2.9 (95% CI 1.24–6.44)
Absolute Event Rate: 80% vs 57%
p-value: p=0.014
High-power and very high-power short-duration RF ablation for AF improves procedural efficiency, first-pass isolation rates, and mid-term success compared to conventional low-power long-duration ablation.
May enhance FPI rates with HPSD/vHPSD in PVI; leaves open long-term efficacy and safety versus LPLD.
Introduction High-power short-duration (HPSD) radiofrequency ablation has been proposed to produce rapid and effective lesions for pulmonary vein isolation (PVI). We aimed to evaluate the procedural characteristics and the first-pass isolation (FPI) rate of HPSD and very high-power short-duration (vHPSD) ablation compared to the low-power long-duration (LPLD) ablation technique. Methods One hundred fifty-six patients with atrial fibrillation (AF) were enrolled and assigned to LPLD, HPSD, or vHPSD PVI. The energy setting was 30, 50, and 90 W in the LPLD, HPSD, and vHPSD groups, respectively. In the vHPSD group, 90 W/4 s energy delivery was used in the QMODE+ setting. In the other groups, ablation index-guided applications were delivered with 30 W (LPLD) or 50 W (HPSD). Results Bilateral PVI was achieved in all cases. Compared to the LPLD group, the HPSD and vHPSD groups had shorter procedure time [85 (75–101) min, 79 (65–91) min, and 70 (53–83) min], left atrial dwelling time [61 (55–70) min, 53 (41–56) min, and 45 (34–52) min], total RF time [1,567 (1,366–1,761) s, 1,398 (1,021–1,711) s, and 336 (247–386) s], but higher bilateral FPI rate (57, 78, and 80%) (all p -values < 0.01). The use of HPSD (OR = 2.72, 95% CI 1.15–6.44, p = 0.023) and vHPSD (OR = 2.90, 95% CI 1.24–6.44, p = 0.014) ablation techniques were associated with a higher probability of bilateral FPI. The 9-month AF-recurrence rate was lower in case of HPSD and vHPSD compared to LPLD ablation (10, 8, and 36%, p = 0.0001). Moreover, the presence of FPI was associated with a lower AF-recurrence rate at 9-month (OR = 0.09, 95% CI 0.04–0.24, p = 0.0001). Conclusion Our prospective, observational cohort study showed that both HPSD and vHPSD RF ablation shortens procedure and RF time and results in a higher rate of FPI compared to LPLD ablation. Moreover, the use of HPSD and vHPSD ablation increased the acute and mid-term success rate. No safety concerns were raised for HPSD or vHPSD ablation in our study.
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Salló et al. (2022) conducted a cohort in Atrial fibrillation (n=156). Very high-power short-duration (vHPSD) ablation vs. Low-power long-duration (LPLD) ablation (30 W) was evaluated on Bilateral first-pass isolation (FPI) (OR 2.90, 95% CI 1.24-6.44, p=0.014). Very high-power short-duration ablation significantly increased the probability of bilateral first-pass isolation compared to low-power long-duration ablation (OR 2.90).
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