Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y
50 Watts high power short duration radiofrequency ablation for atrial fibrillation using temperature- versus ablation-index control
D. Guckel1, L. Bergau1, M. Braun1, M. El Hamriti1, M. Mörsdorf1, T. Fink1, V. Sciacca1, M. Khalaph1, G. Imnadze1, P. Sommer1, C. Sohns1
1Klinik für Elektrophysiologie/ Rhythmologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;

Introduction

Radiofrequency-guided catheter ablation (RFCA) is an established treatment option for atrial fibrillation (AF). Approaches applying higher energy levels for shorter periods (high power short duration, HPSD) to improve lesion formation have been introduced. Data on a direct comparison of a temperature-controlled versus an ablation index (AI) -guided 50 Watts HPSD RFCA approach are lacking.

Objectives

This single center study aimed to compare the efficacy, safety and lesion formation using the novel DiamondTemp (DT) catheter to an AI-guided HPSD ablation protocol using a force-sensing catheter with surround-flow irrigation.

Methods

113 consecutive patients undergoing radiofrequency-guided catheter ablation (RFCA) for AF were included. 45 patients treated with the DT catheter (50 W, 9 sec), were compared to 68 consecutive patients undergoing AI-guided ablation (AI anterior 550; AI posterior 400) adherent to a 50W HPSD protocol. Procedural data and AF- recurrence were evaluated. Follow-up examinations were scheduled after 3 and 6 months.

Results

Acute procedural success was achieved in all patients (n=113, 100%). DT-guided AF ablation was associated with a longer mean procedure duration (99.10±28.30 min vs. 78.24±25.55, p<0.001) and more RF applications (75.24±30.76 min vs. 61.27±14.06, p=0.019). RF duration (792.13±311.23 sec vs. 1035.54±287.24 sec, p<0.001) and fluoroscopy dose (183.81±178.13 yGym2 vs. 295.80±247.54 yGym2, p=0.013) were lower in the DT group. AI-guided HPSD was associated with a higher AF-free survival rate without reaching statistical significance (p=0.088). Especially patients with PERS AF (p=0.009) as well as patients with additional atrial arrhythmia substrate (p=0.002) benefited from an AI-guided ablation strategy.

Conclusion

Temperature- and AI- controlled HPSD RFCA using 50W was safe and effective. AI-guided HPSD ablation improved procedure duration and the need for RF applications. Particularly in advanced AF, freedom from AF-recurrence was superior in the AI-guided HPSD cohort.

https://dgk.org/kongress_programme/ht2022/aP300.html