High-power, short-duration ablation versus conventional technique in Box isolation for atrial fibrillation

Catheter ablation is the cornerstone of the rhythm control treatment of atrial fibrillation (AF). During this procedure, creating a contiguous and durable lesion set is essential to achieve good long-term results. Radiofrequency lesions are created in two phases: resistive and conductive heating. The ablation catheters and the generators have undergone impressive technical developments to enable homogenous and good-quality lesion creation. Despite recent years’ achievements, the durable isolation of the pulmonary veins remains a challenge. These days, intensive research aims to evaluate the role of high-power radiofrequency applications in the treatment of patients with cardiac arrhythmias. The use of high-power, short-duration applications might result in a uniform, transmural lesion set. It is associated with shorter procedure time, shorter left atrial, and fluoroscopy time than low-power ablation. This technique was also associated with a better clinical outcome, possibly due to the better durability of lesions. Multiple clinical studies have proven the safety and efficacy of high-power, short-duration PVI.

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Efficacy and safety of 50-60 Watt high-power short-duration radiofrequency catheter ablation of atrial fibrillation: A propensity score matching study

EP Europace ◽

10.1093/europace/euab116.210 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

HN Pak ◽

SY Yang ◽

M Kim ◽

HT Yu ◽

TH Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Propensity Score ◽

Propensity Score Matching ◽

Short Duration ◽

High Power ◽

Volume Index ◽

Ablation Lesion ◽

Efficacy And Safety ◽

Clinical Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although high-power short-duration (HPSD) radiofrequency (RF) energy is commonly utilized in atrial fibrillation (AF) catheter ablation (CA), its efficacy, safety, and autonomic neural effects have not yet been evaluated in a large patient number. We compared HPSD-AFCA and conventional power (ConvP)-AFCA after propensity score matching. Methods Among 3,221 consecutive AF ablation patients, we included 1,720 patients (74.4% male, 59 ± 10 years old, 56.5% paroxysmal type) who underwent AFCA after propensity score matching: 430 in 50∼60W HPSD group vs. 1,290 in the ConvP group. We evaluated the procedural factors, complication risk, rhythm outcome, and 3-month heart rate variability (HRV) between the two groups and subgroups. Results Procedure times were significantly shorter in the HPSD group (p < 0.001), but the complication rate (p = 0.088) and the 3rd-month HRV did not differ between the two groups. At the 12-month follow-up, rhythm outcomes did not differ between the two groups (Overall, Log-rank p = 0.212; anti-arrhythmic drug off Log rank p = 0.246). These efficacy and safety outcomes were consistently similar regardless of the AF type or ablation lesion set. In the Cox regression analysis, the left atrium volume index measured by computed tomography (HR 1.009 [1.003-1.015]), p = 0.005) and extra-pulmonary vein triggers (HR 1.587 [1.033-2.440], p = 0.035) were independently associated with 1-year clinical recurrence, while the HPSD strategy was not (HR 1.188 [0.903-1.564], p = 0.218). Conclusions HPSD-AFCA significantly shortened the procedure time with similar rhythm outcomes, complication risks, and autonomic neural effects as ConvP-AFCA, regardless of the AF type or ablation lesion set. Abstract Figure.

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High‐power short duration and low‐power long duration in atrial fibrillation ablation: A meta‐analysis

Journal of Cardiovascular Electrophysiology ◽

10.1111/jce.14806 ◽

2020 ◽

Author(s):

Jakrin Kewcharoen ◽

Chol Techorueangwiwat ◽

Chanavuth Kanitsoraphan ◽

Thiratest Leesutipornchai ◽

Nazem Akoum ◽

...

Keyword(s):

Atrial Fibrillation ◽

Low Power ◽

Short Duration ◽

High Power ◽

Meta Analysis ◽

Atrial Fibrillation Ablation ◽

Long Duration

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High-power, short-duration atrial fibrillation ablations using contact force sensing catheters: Outcomes and predictors of success including posterior wall isolation

Heart Rhythm ◽

10.1016/j.hrthm.2020.03.022 ◽

2020 ◽

Vol 17 (8) ◽

pp. 1223-1231 ◽

Cited By ~ 2

Author(s):

Roger A. Winkle ◽

R. Hardwin Mead ◽

Gregory Engel ◽

Melissa H. Kong ◽

Jonathan Salcedo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

Contact Force ◽

High Power ◽

Posterior Wall ◽

Force Sensing ◽

Predictors Of Success

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High-Power Short-Duration Atrial Fibrillation Ablation: Strategy to Reduce Luminal Esophageal Temperature With Contact Force Catheters

SSRN Electronic Journal ◽

10.2139/ssrn.3818015 ◽

2021 ◽

Author(s):

Fabricio Sarmento Vassallo ◽

Lucas Luis Meigre ◽

Eduardo Giestas Serpa ◽

Christiano Lemos da Cunha ◽

Aloyr Gonçalves Simões Jr. ◽

...

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

Contact Force ◽

High Power ◽

Atrial Fibrillation Ablation ◽

Esophageal Temperature

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Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation

EP Europace ◽

10.1093/europace/euz342 ◽

2019 ◽

Vol 22 (3) ◽

pp. 388-393 ◽

Cited By ~ 15

Author(s):

Marc Kottmaier ◽

Miruna Popa ◽

Felix Bourier ◽

Tilko Reents ◽

Jairo Cifuentes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Short Duration ◽

Pulmonary Vein Isolation ◽

High Power ◽

Paroxysmal Atrial Fibrillation ◽

Pericardial Tamponade ◽

Standard Group ◽

Short Period ◽

Procedural Time

Abstract Aims Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) in patients with paroxysmal atrial fibrillation (PAF) is effective but hampered by pulmonary vein reconnection due to insufficient ablation lesions. High-power delivery over a short period of time (HPSD) in RFA is stated to create more efficient lesions. The aim of this study was to compare intraprocedural safety and outcome of HPSD ablation to conventional power settings in patients undergoing PVI for PAF. Methods and results We included 197 patients with PAF that were scheduled for PVI. An ablation protocol with 70 W and a duration cut-off of 7 s at the anterior left atrium (LA) and 5 s at the posterior LA (HPSD group; n = 97) was compared to a conventional power protocol with 30–40 W for 20–40 s (standard group; n = 100) in terms of periprocedural complications and a 1-year outcome. The HPSD group showed significantly less arrhythmia recurrence during 1-year follow-up with 83.1% of patients free from atrial fibrillation compared to 65.1% in the standard group (P < 0.013). No pericardial tamponade, periprocedural thromboembolic complications, or atrio-oesophageal fistula occurred in either group. Mean radiofrequency time (12.4 ± 3.4 min vs. 35.6 ± 12.1 min) and procedural time (89.5 ± 23.9 min vs. 111.15 ± 27.9 min) were significantly shorter in the HPSD group compared to the standard group (both P < 0.001). Conclusion High-power short-duration ablation demonstrated a comparable safety profile to conventional ablation. High-power short-duration ablation using 70 W for 5–7 s leads to significantly less arrhythmia recurrences after 1 year. Radiofrequency and procedural time were significantly shortened.

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