Cerebral Safety Comparison: High‐Power vs. Low‐Power Ablation in AF Pulmonary Vein Isolation

BACKGROUND: The use of high-power short-duration radiofrequency ablation techniques for atrial fibrillation (AF) treatment has gained popularity; however, the implications for cerebral safety, particularly regarding the risk of silent cerebral embolism (SCE), remain unclear. This study aims to assess procedural complications, focusing on cerebral safety, between HPSD and LPLD ablation techniques in patients who are receiving pulmonary vein isolation for AF. METHODS: This study comprised 74 patients who were randomly allocated into two equal groups at a 1:1 ratio. The HPSD group utilized a 70 W, whereas the LPLD group employed a 40 W. The study evaluated safety (asymptomatic cerebral embolism, bleeding, and steam pop incidence) and efficacy (ablation time and success rates) between the groups. RESULTS: In the HPSD group, 9 (26%) patients experienced SCE, compared to 12 (33%) patients in the LPLD group. The two groups did not differ significantly (p = 0.482). There were no clinically evident cerebrovascular events (stroke or TIA) in any patients. The incidence of steam pops was comparable (5% vs. 3%, p = 0.556). Significant differences were observed in ablation times for the left (218.70 ± 96.48 vs. 600.27 ± 249.83 s, p < 0.001) and right pulmonary veins (224.05 ± 77.89 vs. 658.38 ± 168.84 s, p < 0.001). A single case of hematoma was reported in the LPLD group. CONCLUSIONS: The incidence of SCE during PVI ablation is similar between HPSD and LPLD techniques. HPSD ablation is a safe and effective technique that significantly reduces ablation time without elevating perioperative complications.