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Multicenter Study
. 2025 Jun 3;27(6):euae284.
doi: 10.1093/europace/euae284.

Temperature-guided high and very high-power short duration ablation for atrial fibrillation treatment: the peQasus multicentre study

Christian-Hendrik Heeger  1   2   3 , Alexandre Almorad  4   5 , Daniel Scherr  6 , Nándor Szegedi  7 , Sebastian Seidl  8 , Jakub Baran  9   10 , Mattias Duytschaever  11 , Dhiraj Gupta  12 , Dominik Linz  13 , Evgeny Lyan  14 , Domenico Della Rocca  4 , László Gellér  7 , Sebastien Knecht  11 , Peter Calvert  12 , Samuel Meilak  15   16 , Georgios Leventopoulos  17 , Sorin Stefan Popescu  2 , Martin Rauber  6   18 , Georgios Kollias  19 , Michał Niedzwiedz  10 , Andrea Sarkozy  4   5 , Marc Badoz  20 , Martin Manninger-Wünscher  6 , Vanessa Sciacca  21 , Christian Sohns  21 , Matthew R Ginks  22 , Helmut Pürerfellner  19 , Roland R Tilz  2   3
Affiliations
Multicenter Study

Temperature-guided high and very high-power short duration ablation for atrial fibrillation treatment: the peQasus multicentre study

Christian-Hendrik Heeger et al. Europace. .

Abstract

Aims: Temperature-controlled high-power short-duration (HPSD) radiofrequency catheter ablation for pulmonary vein isolation (PVI) utilizing a novel ablation catheter (QDOT Micro) with real-time assessment of catheter tip temperature aims for safer, more effective, and faster procedures.

Methods and results: The peQasus study is a large European multicentre study set up to assess safety, acute efficacy, and outcomes of temperature-controlled HPSD-based PVI. The primary endpoints were safety, efficacy, and 12-month freedom from atrial tachyarrhythmias. Additionally, two strategies namely very HPSD (90 W for 4 s) only and a hybrid approach (HPSD with maximum of 50 W and vHPSD) were compared. A total of 1023 AF patients in 15 centres from nine European countries received PVI with the QDOT. Complete PVI was successfully achieved in all patients. In 699/1023 (68.3%), the vHPSD-only approach (vHPSD group) and in 324/ (31.7%) patients, the hybrid approach (hybrid group) was utilized. The mean procedure duration was 98.4 ± 37.4 min (vHPSD: 88.2 ± 34.9 min, hybrid: 117.4 ± 32.7 min, P < 0.001). The first-pass isolation rate of all PVs was 64% (vHPSD: 62.6%, hybrid: 67.1%, P = 0.187). Severe adverse events were observed in 1.7% (vHPSD: 1.6%, hybrid: 1.9%, P = 0.746). Twelve-month arrhythmia-recurrence-free survival was 77.1% (vHPSD: 76.8%, hybrid: 77.8%, P = 0.241).

Conclusion: In this large multicentre study, temperature-controlled HPSD and vHPSD ablation via a novel ablation catheter provides safe and effective PVI with a relatively short procedure duration. Despite a shorter procedure time, no differences in terms of safety and freedom from arrhythmia recurrence were found irrespective of utilizing vHPSD or the hybrid approach.

Keywords: Acute efficacy; Atrial fibrillation; High-power short duration; Pulmonary vein isolation; Radiofrequency.

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Conflict of interest statement

Conflict of interest: C.-H.H.: received travel grants and research grants by Abbott, Boston Scientific, Biosense Webster Biotronik, Medtronic, Cardiofocus, and Lifetech and speaker’s honoraria from Abbott, Boston Scientific, Biosense Webster Biotronik, Medtronic, Cardiofocus, and Lifetech. R.R.T.: is a consultant for Boston Scientific, Philips, Medtronic Biosense Webster, and Abbott Medical, received speaker’s honoraria from Boston Scientific, Biotronik, Biosense Webster, Abbott Medical, Lifetech, and Pfizer, and research grants from Abbott, Biotronik, Medtronic, Biosense Webster, and Lifetech. He received travel grants from Abbott, Biosense Webster, Boston Scientific, Medtronic, and Philips. H.P.: consultancy and speaker fees from Abbott, Biosense Webster, Biotronik, Boston, and Medtronic. C.S.: received research support and lecture fees from Medtronic, Abbott, Boston Scientific, and Biosense Webster; is a consultant for Medtronic, Boston Scientific, and Biosense Webster; and has received grant support from the Else Kröner-Fresenius-Stiftung and Deutsche Herzstiftung. G.L.: speaker honoraria from Medtronic, Abbott, and Biosense Webster. N.S.: consulting and speaker fees from Biosense Webster, Abbott, and Boston Scientific, not related to the present study. M.R.G.: speaker bureau for Biosense Webster and Abbott. J.B.: consultancy and speaker fees from Biosense Webster, Boston, and Medtronic. All other authors: no current relevant conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Safety, efficacy, and outcomes of temperature-guided (very) high-power short duration ablation for atrial fibrillation—the peQasus multicentre study
Figure 1
Figure 1
peQasus study. Overview and main findings: peQasus multicentre study.
Figure 2
Figure 2
Final lesions set after vHPSD-only (A) and hybrid (B) approaches. Three-dimensional electroanatomical reconstruction (CARTO 3, UNIVIEW module, Biosense Webster) of the left atrium in posterior anterior (left) view. (A) Please note the two circles of very high-power short duration applications by 90 W/4 s (QMODE+ mode, red–black tags) utilizing a very high-power short duration only approach. (B) Please note the two circles of the hybrid approach utilizing very high-power short duration applications by 90 W/4 s (QMODE+ mode, red–black tags) posterior and high-power short duration applications by 50 W (QMODE, ablation index-guided applications, red tags) anterior encircling the right and left pulmonary veins.
Figure 3
Figure 3
Periprocedural data: (A) procedure time, (B) left atrial dwelling time, (C) total radiofrequency time, (D) delivered energy/lesion.
Figure 4
Figure 4
Twelve-month follow-up and findings of repeat procedures. (A) Kaplan–Meier Estimates with 12-month follow-up after the index PVI utilizing the QDOT Micro ablation catheter—all patients. (B) Kaplan–Meier Estimates with 12-month follow-up after the index PVI utilizing the QDOT Micro ablation catheter and comparison of the vHPSD strategy and hybrid approaches. No statistical differences were found concerning 12-month freedom from atrial tachyarrhythmias. (C) Comparison of the PVI vs. PVI+ strategies. No statistical differences were found concerning 12-month freedom from atrial tachyarrhythmias. PVI+ = PVI plus CTI and/or LA ablation. (D) Comparison of the patients with PAF vs. PersAF. A statistical better outcome for PAF patients has been observed.
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References

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