Acute and long-term efficacy of ablation index-guided higher power shorter duration ablation in patients with atrial fibrillation: A prospective registry

So-Ryoung Lee, Hyoung-Seob Park, Eue-Keun Choi, Euijae Lee, Seil Oh, So-Ryoung Lee, Hyoung-Seob Park, Eue-Keun Choi, Euijae Lee, Seil Oh

Abstract

Background: Theoretically, targeting the same ablation index (AI) using higher power may achieve the same lesion size with a shorter ablation time. We evaluated the acute and long-term efficacy of higher-powered ablation guided by ablation index (HPAI) compared with conventional-powered ablation guided by AI (CPAI) for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF).

Methods: Drug refractory symptomatic AF patients who had been ablated with 40 W on the anterior/roof segments and 30 W on the posterior/inferior/carina segments were enrolled (HPAI group). We compared the HPAI group with the CPAI group who were ablated with 30 W on the anterior/roof segments and 25 W on the posterior/inferior/carina segments. The same AI was targeted (≥450 on the anterior/roof segments and ≥350 on the posterior/inferior/carina segments). We compared ablation time, acute pulmonary vein reconnection (PVR) and 1-year AF recurrence between the two groups.

Results: A total of 118 patients were included (86 in the HPAI group and 32 in the CPAI group, paroxysmal AF, 73%). There was no significant difference in the acute PVR rate between the HPAI and the CPAI groups (3.7% vs. 4.2%, P = .580) with a 41% reduction in ablation time for PVI (38.7 ± 8.3 vs. 65.8 ± 13.7 minutes, P < .001). The 1-year AF recurrence rate was not significantly different between HPAI and CPAI groups (12.8% vs. 21.9%, Log-rank P = .242). There were no major complications in either group.

Conclusions: Increased power during AF ablation, using the same AI targets, reduced the procedure and ablation times, and showed a comparable acute and long-term outcome without compromising safety.

Clinical trial registration: https://www.clinicaltrials.gov. Unique identifier: NCT04379557.

Keywords: ablation index; atrial fibrillation; high power ablation; pulmonary vein isolation.

Conflict of interest statement

SRL, HSP, EL, and SO: None; Dr Eue‐Keun Choi received research grants from BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daiichi‐Sankyo, Sanofi‐Aventis, and Skylabs.

© 2021 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.

Figures

FIGURE 1
FIGURE 1
Study design. AI, ablation index; PVAI, pulmonary vein antral isolation
FIGURE 2
FIGURE 2
Comparison of total procedure time, fluoroscopy time, total ablation time, and ablation time for PVI between HPAI and CPAI groups. AI, ablation index; CPAI, conventional‐powered AI‐guided PVI; HPAI, higher‐powered AI‐guided PVI; PVI, pulmonary vein isolation
FIGURE 3
FIGURE 3
Comparison of segments with residual potential and early reconnection after PVI between HPAI and CPAI groups. AI, ablation index; CPAI, conventional‐powered AI‐guided PVI; HPAI, higher‐powered AI‐guided PVI; PVI, pulmonary vein isolation; PVR, pulmonary vein reconnection
FIGURE 4
FIGURE 4
Kaplan‐Meier curve of freedom from atrial tachyarrhythmia recurrence between HPAI and CPAI groups. AF, atrial fibrillation; AT, atrial tachycardia; CPAI, conventional‐powered AI‐guided PVI; HPAI, higher‐powered AI guided PVI; PVI, pulmonary vein isolation
FIGURE 5
FIGURE 5
Summary of previous studies applying high RF power during PVI. AF, atrial fibrillation; AI, ablation index; CON, conventional power; HP, high power; ILD, interlesion distance; LP, low power; MP, medium power; PVI, pulmonary vein reconnection; PVR, pulmonary vein reconnection; RF, radiofrequency; STSF, SmartTouchSurroundFlow®

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