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. 2023 Jul 28;12(15):4986.
doi: 10.3390/jcm12154986.

Short and Long-Term Outcomes of Lesion Index-Guided High-Power Short-Duration Approach for Atrial Fibrillation Ablation

Andrea Di Cori  1 , Matteo Parollo  1 , Francesco Gentile  1 , Lorenzo Pistelli  1   2 , Carlo Vitale  1 , Salvatore Della Volpe  1 , Mario Giannotti Santoro  1 , Lorenzo Mazzocchetti  1 , Raffaele De Lucia  1 , Antonio Canu  1 , Valentina Barletta  1 , Gino Grifoni  1 , Luca Segreti  1 , Maria Grazia Bongiorni  1 , Giulio Zucchelli  1
Affiliations

Short and Long-Term Outcomes of Lesion Index-Guided High-Power Short-Duration Approach for Atrial Fibrillation Ablation

Andrea Di Cori et al. J Clin Med. .

Abstract

High-power short-duration (HPSD) ablation is an increasingly used ablation strategy for pulmonary vein isolation (PVI) procedures, but Lesion Index (LSI)-guided HPSD radiofrequency (RF) applications have not been described in this clinical setting. We evaluated the procedural efficiency and safety of an LSI-guided HPSD strategy for atrial fibrillation (AF) ablation. Paroxysmal and persistent AF patients scheduled for AF ablation were prospectively enrolled and divided into two groups, according to the ablation power used (≥45 W for the LSI-HP Group and ≤40 W for the LSI-LP group). All patients underwent only PVI LSI-guided ablation (5.5 to 6 anteriorly; 5 to 5.5 superiorly, 4.5 to 5 posteriorly) with a point-by-point strategy and an inter-lesion distance <6 mm. Forty-six patients with AF (25 in the LSI-HP Group vs 21 in the LSI-LP Group)-59% paroxysmal, 78% male, with low-intermediate CHA2DS2-Vasc scores (2 [1-3]), a preserved ejection fraction (65 ± 6%) and a mean left atrial index volume of 39 ± 13 mL/m2 were prospectively enrolled. Baseline clinical characteristics were comparable between groups. PVI was successful in all patients. The RF time (29 (23-37) vs. 49 (41-53) min, p < 0.001), total procedure time (131 (126-145) vs. 155 (139-203) min, p = 0.007) and fluoroscopy time (12 (10-18) vs. 21 (16-26) min, p = 0.001) were significantly lower in the LSI-HP Group. No complications or steam pops were seen in either group. LSI-HP AF ablation significantly improved procedural efficiency-reducing ablation time, total procedural duration, and fluoroscopy use, while maintaining a comparable safety profile to lower-power procedures.

Keywords: atrial fibrillation; atrial fibrillation ablation; high-power short-duration; lesion index; pulmonary vein isolation.

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Conflict of interest statement

Authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Electroanatomical map of LA and PV after continuous circular RF application. (A). Left Anterior Oblique view. (B). Postero-anterior view. (C). The color of the Automarks are coded according to the LSI target. The color of the Automarks are coded according to the LSI target. PVI, pulmonary vein isolation; LA, left atrium; LSI, ablation index; PV, pulmonary vein; RF, radiofrequency.
Figure 2
Figure 2
Procedural times in patients undergoing a high-power short-duration (HPSD) vs. a traditional ablation procedure.
Figure 3
Figure 3
Kaplan–Meier curves for the risk of atrial fibrillation (AF) recurrence during follow-up in patients undergoing a high-power short-duration (HPSD) vs. a traditional ablation procedure.
Figure 4
Figure 4
Kaplan–Meier curves for the risk of atrial fibrillation (AF) recurrence during follow-up in patients undergoing a high-power short-duration (HPSD) vs. a traditional ablation procedure with either paroxysmal or persistent AF.
See this image and copyright information in PMC

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