High‐power, short‐duration atrial fibrillation ablation compared with a conventional approach: Outcomes and reconnection patterns. (29th March 2021)

• Record Type: Journal Article
• Authors: Hansom, Simon P.; Alqarawi, Wael; Birnie, David H.; Golian, Mehrdad; Nery, Pablo B.; Redpath, Calum J.; Klein, Andres; Green, Martin S.; Davis, Darryl R.; Sheppard‐Perkins, Eva; Ramirez, F. Daniel; Nair, Girish M.; Sadek, Mouhannad M.
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 32:Number 5(2021)
• Page Start: 1219
• Page End: 1228
• Publication Date: 2021-03-29
• Subjects: atrial fibrillation ablation -- high‐power short‐duration ablation -- pulmonary vein reconnection patterns; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.14989
• Languages: English
• ISSNs: 1045-3873

Abstract

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 ≥ 300 g ·s) and ≤35 W anteriorly (FTI ≥ 400 g ·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.