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. 2021 May;32(5):1219-1228.
doi: 10.1111/jce.14989. Epub 2021 Mar 29.

High-power, short-duration atrial fibrillation ablation compared with a conventional approach: Outcomes and reconnection patterns

Simon P Hansom  1 , Wael Alqarawi  1 , David H Birnie  1 , Mehrdad Golian  1 , Pablo B Nery  1 , Calum J Redpath  1 , Andres Klein  1 , Martin S Green  1 , Darryl R Davis  1 , Eva Sheppard-Perkins  1 , F Daniel Ramirez  1 , Girish M Nair  1 , Mouhannad M Sadek  1
Affiliations

High-power, short-duration atrial fibrillation ablation compared with a conventional approach: Outcomes and reconnection patterns

Simon P Hansom et al. J Cardiovasc Electrophysiol. 2021 May.

Abstract

Background: The effectiveness, safety, and pulmonary vein (PV) reconnection patterns of point-by-point high-power, short-duration (HPSD) ablation relative to conventional force-time integral (FTI)-guided strategies for atrial fibrillation (AF) ablation are unknown.

Objectives: To compare 1-year freedom from atrial arrhythmia (AA), complication rates, procedural times, and PV reconnection patterns with HPSD AF AF ablation versus an FTI-guided low-power, long-duration (LPLD) strategy.

Methods: We compared consecutive patients undergoing a first ablation procedure for paroxysmal or persistent AF. The HPSD protocol utilized a power of 50 W and durations of 6-8 s posteriorly and 8-10 s anteriorly. The LPLD protocol was FTI-guided with a power of ≤25 W posteriorly (FTI ≥ 300g·s) and ≤35 W anteriorly (FTI ≥ 400g·s).

Results: In total, 214 patients were prospectively included (107 HPSD, 107 LPLD). Freedom from AA at 1 year was achieved in 79% in the HPSD group versus 73% in the LPLD group (p = .339; adjusted hazard ratio with HPSD, 0.67; 95% confidence interval, 0.36-1.23; p < .004 for non-inferiority). Procedure duration was shorter in the HPSD group (229 ± 60 vs. 309 ± 77 min; p < .005). Patients undergoing repeat ablation had a higher propensity for reconnection at the right PV carina in the HPSD group compared with the LPLD group (14/30 = 46.7% vs. 7/34 = 20.6%; p = .035). There were no differences in complication rates.

Conclusion: HPSD AF ablation resulted in similar freedom from AAs at 1 year, shorter procedure times, and a similar safety profile when compared with an LPLD ablation strategy. Patients undergoing HPSD ablation required more applications at the right carina to achieve isolation, and had a significantly higher rate of right carinal reconnections at redo procedures.

Keywords: atrial fibrillation ablation; high-power short-duration ablation; pulmonary vein reconnection patterns.

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References

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