What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation (n=91). Intervention: High-power short-duration (HPSD) ablation index-guided protocol vs. Control single-catheter protocol (25 W posterior, 30 W anterior). Primary outcome: Freedom from recurrence of atrial fibrillation or atrial tachycardia during 1-year follow-up (p=0.67).

What does this research mean for the field?

A high-power short-duration (HPSD) ablation index-guided pulmonary vein isolation protocol using a single catheter significantly reduces procedure and ablation times compared to a standard protocol, while maintaining equivalent safety and 1-year clinical efficacy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

May 20, 2022Open Access

High-power short-duration ablation index–guided pulmonary vein isolation protocol using a single catheter

PBPatrick BadertscherElectrophysiology SKSven KnechtElectrophysiology FSFlorian SpiesUniversity of Basel

Key Result

A high-power short-duration ablation index-guided single-catheter protocol for pulmonary vein isolation achieved similar 1-year freedom from atrial arrhythmias compared to a standard protocol (91% vs 84%, p=0.67).

Study Design

Type

Cohort (n=91)

Multicenter

Structured PICO

Does a high-power short-duration ablation index-guided single-catheter protocol improve procedural efficiency and maintain efficacy compared to a standard single-catheter protocol in patients undergoing pulmonary vein isolation for atrial fibrillation?

Population

91 patients with paroxysmal or persistent atrial fibrillation undergoing first-time single-catheter pulmonary vein isolation, followed for a median of 336 days.

Intervention

High-power short-duration (HPSD) ablation index-guided protocol using a single catheter (power set to 35 W at the posterior wall and 50 W at the anterior wall).

Comparator

Control single-catheter protocol (SP) (power limited to 25 W at the posterior wall and 30 W at the anterior wall).

Outcome

Freedom from recurrence (defined as a 1-year absence of atrial fibrillation or atrial tachycardia episodes > 30 s, beyond the 3-month blanking period).hard clinical

A minimalistic, high-power short-duration single-catheter approach for pulmonary vein isolation significantly reduces procedure and ablation times while maintaining high efficacy and safety.

Main Result

Absolute Event Rate: 91% vs 84%

p-value: p=0.67

Limitations

Retrospective analysis of a prospective database
Patients were not randomized to either ablation protocol
Single-center study design
Did not assess higher power settings (e.g., 60-90 W)
Did not use esophageal monitoring or protection devices
Only evaluated a point-by-point technique without comparison to single-shot devices

Abstract

BACKGROUND: Catheter ablation for atrial fibrillation (AF) is the most commonly performed electrophysiological procedure. To improve healthcare utilization, we aimed to compare the efficacy, efficiency, and safety of a minimalistic, streamlined single catheter ablation approach using a high-power short-duration ablation index-guided protocol (HPSD) vs. a control single-catheter protocol (SP). METHODS: Pulmonary vein isolation (PVI) with a single transseptal puncture without a multipolar mapping catheter was performed in 91 patients. Left atrial mapping was performed with the ablation catheter, only. Pacing maneuvers were used to confirm exit block. Procedural characteristics and success rates were compared using HPSD (n = 34) vs. a control (n = 57) ablation protocol. Freedom from recurrence was defined as a 1-year absence of AF episodes > 30 s, beyond the 3-month blanking period. RESULTS: Using the HPSD protocol the median procedure and RF ablation time were significantly shorter compared to the SP, 84 (IQR 76-100) vs. 118 min (IQR 104-141) and 1036 (898-1184) vs. 1949s (IQR 1693-2261), respectively, p < .001 for all. First-pass PVI was achieved using the HPSD protocol in 88% and using the SP in 87% of patients, p = 1.0. No procedural complications were observed. High-sensitivity cardiac troponin levels were significantly higher in patients using the HPSD protocol compared to the SP. At 12 months follow-up, 87% patients remained free from AF with no differences between groups. CONCLUSIONS: A minimalistic, HPSD ablation index-guided PVI with a single-catheter approach is very efficient, safe, and associated with excellent clinical outcomes at 1 year.

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