Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study

Roland Richard Tilz, Makoto Sano, Julia Vogler, Thomas Fink, Roza Saraei, Vanessa Sciacca, Bettina Kirstein, Huong-Lan Phan, Sascha Hatahet, Lisbeth Delgado Lopez, Anna Traub, Charlotte Eitel, Michael Schlüter, Karl-Heinz Kuck, Christian-Hendrik Heeger, Roland Richard Tilz, Makoto Sano, Julia Vogler, Thomas Fink, Roza Saraei, Vanessa Sciacca, Bettina Kirstein, Huong-Lan Phan, Sascha Hatahet, Lisbeth Delgado Lopez, Anna Traub, Charlotte Eitel, Michael Schlüter, Karl-Heinz Kuck, Christian-Hendrik Heeger

Abstract

Background: Catheter ablation for atrial fibrillation (AF) treatment provides effective and durable pulmonary vein isolation (PVI) and is associated with encouraging clinical outcome. A novel CF sensing temperature-controlled radiofrequency (RF) ablation catheter allows for very high-power short-duration (vHP-SD, 90 W/4 s) ablation aiming a potentially safer, more effective and faster ablation. We thought to evaluate preliminary safety and efficacy of vHP-SD ablation for PVI utilizing a novel vHP-SD catheter. The data was compared to conventional power-controlled ablation index (AI) guided PVI utilizing conventional contact force (CF) sensing catheters.

Methods and results: Fifty-six patients with paroxysmal or persistent AF were prospectively enrolled in this study. Twenty-eight consecutive patients underwent vHP-SD based PVI (vHP-SD group) and were compared to 28 consecutive patients treated with conventional CF-sensing catheters utilizing the AI (control group). All PVs were successfully isolated using vHP-SD. The median RF ablation time for vHP-SD was 338 (IQR 286, 367) seconds vs control 1580 (IQR 1350, 1848) seconds (p < 0.0001), the median procedure duration was vHP-SD 55 (IQR 48-60) minutes vs. control 105 (IQR 92-120) minutes (p < 0.0001). No differences in periprocedural complications were observed.

Conclusions: This preliminary data of the novel vHP-SD ablation mode provides safe and effective PVI. Procedure duration and RF ablation time were substantially shorter in the vHP-SD group in comparison to the control group.

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

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: CHH received travel grants and research grants by Boston Scientific, Biosense Webster and Cardiofocus and Speakeŕs Honoraria from Boston Scientific, Biosense Webster and Cardiofocus. RRT is a consultant of Boston Scientific, Biotronik and Biosense Webster and received Speakeŕs Honoraria from Biosense Webster, Medtronic, Boston Scientific and Abbot Medical. KHK reports grants and personal fees from Abbott Vascular,. Medtronic, Biosense Webster outside submitted work. All other authors have no relevant disclosures.

© 2021 Published by Elsevier B.V.

Figures

Fig. 1
Fig. 1
QDOT Micro ablation catheter and QMODE+ A: Three-dimensional electroanatomic reconstruction (CARTO 3, UNIVIEW module, Biosense Webster) of the left atrium of case #2 in PA view. Please note the two circles depicted through red-white tags created by radiofrequency ablation utilizing the QDOT Micro catheter in the QMODE+ ablation mode. The data of location 1 ablation point is depicted in the right sided diagram of the figure and shows the biophysics parameters of a very-high power short duration ablation by 90 W/4 s. The parameters of power (W) Impedance (Ω), temperature (°C) and contact force (g) are shown. B: Picture of the QDOT Micro catheter tip showing the three micro-electrodes on top of the tip. The black arrow highlights one micro-electrode. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 2
Fig. 2
Periprocedural data:Periprocedural duration (A): Procedure time, (B): left atrial dwelling time, (C): Total radiofrequency time, (D) total mean power/application and (E) total delivered energy of the QMODE+ (vHP-SD group) compared to the control group. W = Watts, J = Joules.

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