Evaluation of higher power delivery during RF pulmonary vein isolation using optimized and contiguous lesions. (18th March 2020)

• Record Type: Journal Article
• Authors: Kyriakopoulou, Maria; Wielandts, Jean‐Yves; Strisciuglio, Teresa; El Haddad, Milad; Pooter, Jan De; Almorad, Alexandre; Hilfiker, Gabriela; Phlips, Thomas; Unger, Philippe; Lycke, Michelle; Vandekerckhove, Yves; Tavernier, Rene; Duytschaever, Mattias; Knecht, Sebastien
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 31:Number 5(2020)
• Page Start: 1091
• Page End: 1098
• Publication Date: 2020-03-18
• Subjects: atrial fibrillation -- contact force -- high power ablation -- pulmonary vein isolation; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.14438
• Languages: English
• ISSNs: 1045-3873

Abstract

Abstract: Aims: "CLOSE"‐guided pulmonary vein isolation (PVI) is based on contiguous (≤6 mm) and optimized radiofrequency (RF) ablation lesions (ablation index [AI] ≥ 400 posteriorly and ≥ 550 anteriorly]. However, the optimal RF power to reach the desired AI is unknown. Therefore we evaluated the efficiency of an ablation strategy using higher power (40 W) during a first "CLOSE"‐guided PVI. Methods: Eighty consecutive patients undergoing "CLOSE"‐guided PVI for symptomatic paroxysmal atrial fibrillation were ablated with 40 W (group A). Results were compared with 105 consecutive patients enrolled in the "CLOSE to CURE"‐study and were ablated using the same protocol with 35 W (group B). Results: In group A, ablation was associated with shorter ablation procedure time (91 vs 111 minutes; P < .001), shorter fluoroscopy time (5 vs 11 minutes; P < .001), shorter PVI time (48 vs 64 minutes; P < .001), shorter RF time (20 vs 28 minutes; P < .001), lower RF time per application (22 vs 29 seconds; P < .001), less RF applications (52 vs 58; P < .001), and less catheter dislocations (1 vs 2; P = .002). The impedance drop (12 vs 13 Ω; P = .192), first‐pass isolation rate (99% vs 93%; P = .141) and acute reconnection rate (6% vs 4%; P > .733) were similar in both groups (groups A and B, respectively). No complications occurred. In group A, a gastroscopy—performed in five patients with esophageal temperature rise more than 42°C—did not reveal any esophageal lesion. Postprocedural recurrence of atrial tachyarrhythmia at 1 year was not significantly different between both groups. Conclusions: Using the "CLOSE"‐protocol, increased power increases the efficiency of PVI without compromising patients' safety.