Abstract 151 Safety and outcome of very high power short duration with 90W compared to 50W for AF ablation

Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9
Safety and outcome of very high power short duration with 90W compared to 50W for AF ablation
J. Müller¹, A. Berkovitz¹, P. Halbfaß¹, K. Nentwich¹, E. Ene¹, K. Sonne¹, G. Simu¹, I. Chakarov¹, T. Deneke¹
¹Klinik für Kardiologie II / Interventionelle Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale;
Background: Pulmonary vein isolation (PVI) is an effective treatment option for patients with atrial fibrillation (AF). This study sought to evaluate the impact of different ablation settings for PVI. Methods: Consecutive patients undergoing AF ablation including PVI with vHPSD (90W; predefined ablation time of 3 seconds for posterior wall ablation; predefined ablation time of 4 seconds for anterior wall ablation) were compared with patients using HPSD (50W; ablation index-guided; AI 350 for posterior wall ablation, AI 450 for anterior wall ablation) for AF ablation. Only patients with first PVI were included. Periprocedural data were recorded. Short-term endpoints included intraprocedural reconnection after initial isolation of at least one PV, intrahospital AF recurrence and incidence of thermal esophageal injury. Mid-term endpoint was AF recurrence at 3 months. Results: A total of 400 patients (67.1 ± 9.8 years; 58% male; 47% paroxysmal AF) were included. 45 patients were treated with 90W, 355 with 50W. The HPSD group revealed shorter procedural times (88.8 ± 20.5 min vs. 78.9 ± 23.4 min; p=0.009), the vHPSD group shorter ablation times (10.5 ± 6.7 min vs. 17.5 ± 10.8 min; p=0.003). No major complication such as pericardial tamponade, periprocedural thromboembolic complications or atrio-esophageal fistula occurred. Intraprocedural reconnection (33% vs. 20%; p=0.035) occurred more often using vHPSD with also a trend towards increased intrahospital AF recurrence (16% vs. 8%; p=0.086). Incidence of thermal esophageal injury was equally distributed (2% vs. 5%; p=0.354). At short-term follow-up, patients undergoing AF ablation with 90W revealed a statistical trend towards higher AF recurrences (38% vs. 24%; log rank p=0.074). Conclusions: AF ablation using 90W vHPSD reveals a similar safety profile compared to 50W ablation with shorter ablation times. However, increased intraprocedural PV reconnections as well as indications of increased intrahospital AF recurrences and even at short-term follow-up need further investigation.
https://dgk.org/kongress_programme/ht2021/P903.htm