Background: High Power Short Duration (HPSD) ablation has been shown to be feasible for atrial fibrillation (AF) ablation with short procedure times. In this study we analyzed retrospectively the use of a steerable sheath, which allows for visualization on 3D-Mapping system, compared to classical steerable sheaths.

Methods and Results: 85 patients with atrial fibrillation (paroxysmal and persistent) ablated in High Power Short Duration technique were included in the study. We used a fixed protocol for energy delivery of 50 watts. Two different mapping systems were used. A visible steerable sheath (Biosense Webster, CARTO VIZIGO^TM Guiding Sheath) was used in 43 Patients, a non-visible steerable sheath was used in 42 patients (38x Abbott, Agilis, 4x Biosense Webster, MobiCath). Endpoint of ablation was complete PV entrance and exit block controlled by a at least 10-pole spiral catheter or a high density catheter. Patients in both groups were comparable in age, BMI and CHA2DS2-VASc score. Isolation of pulmonary veins could be achieved in all patients. We observed no major complications in both groups. Acute postinterventional pericarditis or small pericardial effusion was significantly less common in the visible sheath group (2,3 % vs 14,3 %). Procedure time from transseptal puncture to pulling of all sheaths was slightly shorter in the visible sheath group. Moreover, radiation dose was shorter in the visible sheath group.

Conclusions: HPSD using a visible and non-visible steerable sheath reveal a similar safety and efficacy profile for ablation of atrial fibrillation. Procedure time and radiation dose was shorter and postinterventional pericarditis and pericardial effusion was significantly less common in the visible sheath group.