Objectives: To compare one-year freedom from atrial arrhythmia, complication rates, procedural times, and pulmonary vein (PV) reconnection patterns with high-power, short-duration (HPSD) atrial fibrillation (AF) ablation versus an FTI-guided low-power, long-duration (LPLD) strategy.
Background: The effectiveness, safety, and PV reconnection patterns of point-by-point HPSD ablation relative to conventional force-time integral (FTI)-guided strategies for AF are unknown.
Methods: We compared consecutive patients undergoing a first ablation procedure for paroxysmal or persistent AF. The HPSD protocol utilized a power of 50W and durations of 6-8 seconds posteriorly and 8-10 seconds anteriorly. The LPLD protocol was FTI-guided with a power of ≤25W posteriorly (FTI≥300g.s) and ≤35W anteriorly (FTI≥400g.s).
Results: 214 patients were prospectively included (107 HPSD, 107 LPLD). Freedom from AA at one-year was achieved in 79% in the HPSD group versus 73% in the LPLD group (p=0.339; adjusted hazard ratio with HPSD, 0.67; 95% confidence interval, 0.36-1.23; p<0.004 for non-inferiority). Procedure duration was shorter in the HPSD group (229±60 vs 309±77 minutes, p<0.005). Patients undergoing repeat ablation had a higher propensity for reconnection at the right PV carina in the HPSD group compared to the LPLD group (14/30=46.7% vs. 7/34=20.6%, p=0.035). There were no differences in complication rates.
Conclusion: HPSD AF ablation resulted in similar freedom from AAs at one-year, shorter procedure times, and a similar safety profile when compared to a 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. This article is protected by copyright. All rights reserved.
Keywords: Atrial fibrillation ablation; high-power short-duration ablation; pulmonary vein reconnection patterns.