Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y
Safety and long-term efficacy of 50W HPSD AF ablation
J. Müller1, E. Ene2, K. Sonne3, I. Chakarov2, K. Nentwich4, A. Berkovitz5, V. Zhuravlev5, T. Deneke5
1Herz- und Gefäß-Klinik Campus Bad Neustadt, Bad Neustadt a. d. Saale; 2Kardiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; 3Kardiologie II - interventionelle Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; 4Kardiologie II - interventionellen Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale; 5Klinik für Kardiologie II / Interventionelle Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale;

Background: Pulmonary vein isolation (PVI) using high-power short duration (HPSD) radiofrequency (RF) ablation is an effective treatment option for patients with atrial fibrillation (AF). This study aims to investigate the safety and efficacy of this novel apprach.


Methods: Consecutive patients undergoing first AF ablation with HPSD (50W; ablation index (AI)-guided) using the ThermoCool SmartTouch SF DF catheter (CARTO) were included. Patients were devided into paroxysmal (PAF) and persistent AF (perAF) as well as target AI 350 for posterior wall, AI 450 for non-posterior wall vs AI 300/400. Safety endpoints included acute periprocedural complications as well as asymptomatic esopahgeal lesions. Efficacy endpoints included short-term AF recurrences as well as AF recurrence during mean follow-up of 24 months. Furthermore, PV reconnection patterns during redo procedures were investigated.


Results: A total of 795 patients undergoing first AF ablation with HPSD were included (67 years; 58% males; 48% paroxysmal AF). 581 patients (73%) were ablated with target AI 350/450. Mean procedure, fluoroscopy and ablation times were 82.9 min +- 23.7 min, 6.0 min +- 4.0 min and 17.3 min +- 9.7 min, respectively. Complication rates were comparable between all groups, however AI 450/350 showed a strong statistical trend for more thermal esophageal lesions (7% vs 4%; p=0.088). After the follow-up period and a mean of 1.2 procedures, 80% of all patients revealed stable sinus rhythm (AI 450/350 80% vs. AI 400/300 81%; p=0.818; PAF 86% vs. perAF 75%; p=0.001). During redo procedures, most patients (92%) had at least one PV reconnection (mean 2.2 PVs) with no general difference between AI groups. Using multivariable regression models decreased LVEF, persistent AF and female gender were indetified as independent negative predictors for AF recurrence.


Conclusions: AI-guided HPSD AF ablation with 400/300 AI results in comparable overall success rate than 450/350 AI with favourable esophageal safety profil. PV reconnections were comparable between both groups.
https://dgk.org/kongress_programme/ht2022/aP298.html