Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation

Zoltán Salló, Péter Perge, Bernadett Balogi, Gábor Orbán, Katalin Piros, Szilvia Herczeg, Klaudia Vivien Nagy, István Osztheimer, Pál Ábrahám, Béla Merkely, László Gellér, Nándor Szegedi, Zoltán Salló, Péter Perge, Bernadett Balogi, Gábor Orbán, Katalin Piros, Szilvia Herczeg, Klaudia Vivien Nagy, István Osztheimer, Pál Ábrahám, Béla Merkely, László Gellér, Nándor Szegedi

Abstract

Introduction: High-power short-duration (HPSD) radiofrequency ablation has been proposed to produce rapid and effective lesions for pulmonary vein isolation (PVI). We aimed to evaluate the procedural characteristics and the first-pass isolation (FPI) rate of HPSD and very high-power short-duration (vHPSD) ablation compared to the low-power long-duration (LPLD) ablation technique.

Methods: One hundred fifty-six patients with atrial fibrillation (AF) were enrolled and assigned to LPLD, HPSD, or vHPSD PVI. The energy setting was 30, 50, and 90 W in the LPLD, HPSD, and vHPSD groups, respectively. In the vHPSD group, 90 W/4 s energy delivery was used in the QMODE+ setting. In the other groups, ablation index-guided applications were delivered with 30 W (LPLD) or 50 W (HPSD).

Results: Bilateral PVI was achieved in all cases. Compared to the LPLD group, the HPSD and vHPSD groups had shorter procedure time [85 (75-101) min, 79 (65-91) min, and 70 (53-83) min], left atrial dwelling time [61 (55-70) min, 53 (41-56) min, and 45 (34-52) min], total RF time [1,567 (1,366-1,761) s, 1,398 (1,021-1,711) s, and 336 (247-386) s], but higher bilateral FPI rate (57, 78, and 80%) (all p-values < 0.01). The use of HPSD (OR = 2.72, 95% CI 1.15-6.44, p = 0.023) and vHPSD (OR = 2.90, 95% CI 1.24-6.44, p = 0.014) ablation techniques were associated with a higher probability of bilateral FPI. The 9-month AF-recurrence rate was lower in case of HPSD and vHPSD compared to LPLD ablation (10, 8, and 36%, p = 0.0001). Moreover, the presence of FPI was associated with a lower AF-recurrence rate at 9-month (OR = 0.09, 95% CI 0.04-0.24, p = 0.0001).

Conclusion: Our prospective, observational cohort study showed that both HPSD and vHPSD RF ablation shortens procedure and RF time and results in a higher rate of FPI compared to LPLD ablation. Moreover, the use of HPSD and vHPSD ablation increased the acute and mid-term success rate. No safety concerns were raised for HPSD or vHPSD ablation in our study.

Keywords: ablation; atrial fibrillation; first-pass isolation; high-power short-duration; pulmonary vein isolation; very high-power short-duration.

Conflict of interest statement

ZS, NS and LG were received consultation fees from Biosense Webster. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Salló, Perge, Balogi, Orbán, Piros, Herczeg, Nagy, Osztheimer, Ábrahám, Merkely, Gellér and Szegedi.

Figures

FIGURE 1
FIGURE 1
Fast anatomical map of the left atrium with CARTO® 3 system (postero-anterior view). During the ablation, the Lasso™ catheter was placed in the contralateral pulmonary veins to blind the operator to the presence or absence of first-pass isolation.
FIGURE 2
FIGURE 2
Fast anatomical map of the left atrium with CARTO® 3 system (postero-anterior view). After the completion of the circumferential pulmonary vein isolation, the Lasso™ catheter was introduced into the ablated pulmonary veins to assess first-pass isolation. The Lasso™ catheter is in the right superior pulmonary vein.
FIGURE 3
FIGURE 3
Procedure time (A), left atrial dwelling time (B), and radiofrequency ablation time (C) in the different ablation groups. Abbreviations: LDLD, low-power long-duration; HPSD, high-power short-duration; vHPSD, very high-power short-duration; LA, left atrial. *p < 0.05, ****p < 0.0001, nsp ≥ 0.05.
FIGURE 4
FIGURE 4
First pass isolation results in the different ablation groups (A: both sides; B: left side; C: right side). FPI, first-pass isolation; LDLD, low-power long-duration; HPSD, high-power short-duration; vHPSD, very high-power short-duration. *p < 0.05, **p < 0.01, nsp ≥ 0.05.

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