Key result
Fixed 50 W HPSD PVI cuts procedure time by ~29 minutes without increasing complications.
Why the study?
AI-guided ablation via the CLOSE protocol effectively achieves chronic PVI, but the optimal RF power remains controversial.
Does AI-guided fixed 50 W HPSD PVI reduce procedural time without increasing complications compared to standard power settings in patients undergoing PVI?
RCT (n=120)
randomized
No
Does AI-guided fixed 50 W HPSD PVI reduce procedural time without increasing complications compared to standard power settings in patients undergoing PVI?
Absolute Event Rate: 80.3% vs 109.1%
p-value: p=< .001
A fixed 50 W HPSD PVI protocol significantly reduces procedural and radiofrequency times without increasing the rate of esophageal lesions compared to standard power settings.
Enables shorter PVI procedures without added risk; extends RCT evidence for fixed 50 W HPSD CLOSE protocol.
INTRODUCTION: Ablation index (AI)-guided ablation according to the CLOSE protocol is very effective in terms of chronic pulmonary vein isolation (PVI). However, the optimal radiofrequency (RF) power remains controversial. Here, we thought to investigate the efficiency and safety of an AI-guided fixed circumferential 50 W high-power short-duration (HPSD) PVI using the CLOSE protocol. METHODS AND RESULTS: In a single-center trial, 40 patients underwent randomized PVI using AI-guided ablation without esophageal temperature monitoring. In 20 patients a CLOSE protocol guided fixed 50 W HPSD was followed irrespective of the anatomical localization. Twenty subjects were treated according to the CLOSE protocol with standard power settings (20 W posterior and 40 W roof and anterior wall). In addition, 80 consecutive patients were treated according to the HPSD protocol to gather additional safety data. All patients underwent postprocedural esophagogastroduodenoscopy to reveal esophageal lesions (EDELs). The mean total procedural time was 80.3 ± 22.5 in HPSD compared to control 109.1 ± 27.4 min (p < .001). The total RF-time was significantly lower in HPSD with 1379 ± 505 s versus control 2374 ± 619 s (p < .001). There were no differences in periprocedural complications. EDEL occurred in 13% in the HPSD and 10% in the control group. EDEL occurring in the 50 W HSDP patients were smaller, more superficial, and had a faster healing tendency. CONCLUSION: A fixed 50 W HPSD circumferential PVI relying on the AI and CLOSE protocol reduce the total procedure time and the total RF time, without increasing the complication rates. The incidence of EDELs was similar using 50 W at the posterior atrial wall.
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Francke et al. (2021) conducted an RCT in Pulmonary vein isolation (n=120). Fixed 50 W high-power short-duration (HPSD) ablation using the CLOSE protocol vs. Standard power settings (20 W posterior and 40 W roof and anterior wall) using the CLOSE protocol was evaluated on Mean total procedural time (minutes) (p=< .001). Fixed 50 W high-power short-duration PVI using the CLOSE protocol significantly reduced mean total procedural time (80.3 vs 109.1 min; p<0.001) without increasing complication rates.