Procedural Efficiency and Clinical Outcomes of a Region‐Specific Radiofrequency Ablation Strategy for Pulmonary Vein Isolation

Background High‐power short‐duration radiofrequency ablation improves procedural efficiency during pulmonary vein isolation (PVI), but concerns remain regarding lesion transmurality and posterior wall collateral injury. We evaluated whether a region‐specific ablation strategy was associated with improved procedural efficiency without a detected difference in acute efficacy or 12‐month arrhythmia recurrence compared with conventional ablation index‐guided PVI. Methods In this retrospective single‐center study, 250 patients undergoing first‐time PVI were treated with either ablation index‐guided ablation or a region‐specific strategy using very high‐power short‐duration applications on the posterior wall and ablation index‐guided lesions on the anterior wall. The primary endpoint was first‐pass isolation, analyzed per pulmonary vein using generalized estimating equations to account for within‐patient clustering. Secondary endpoints included procedural efficiency, peri‐procedural safety, and 12‐month arrhythmia recurrence. Results First‐pass isolation was achieved in 919 of 1 000 pulmonary veins (91.9%): 454 of 500 veins (90.8%) with the region‐specific strategy and 465 of 500 veins (93.0%) with ablation index‐guided ablation, with no significant between‐group difference (OR, 0.74; 95% CI, 0.41–1.34; p = 0.322). The region‐specific strategy was associated with shorter procedure duration, ablation time, radiofrequency time, fluoroscopy time, and lower radiation dose (all p < 0.001). Acute complications occurred in 4 patients (1.6%). At 12 months, arrhythmia recurrence occurred in 43 patients (17.2%), with no detected difference between strategies. Conclusions A region‐specific ablation strategy improved procedural efficiency without a detected difference in first‐pass isolation or 12‐month arrhythmia recurrence compared with ablation index‐guided PVI.