Abstract 149 Pulmonary vein isolation using high-power short-duration yields less transmural MRI lesions compared to low-power long-duration ablation

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02087-y
Pulmonary vein isolation using high-power short-duration yields less transmural MRI lesions compared to low-power long-duration ablation
M. Forkmann¹, T. Acil¹, M. Mitlacher¹, B. Tose Costa Paiva¹, S. Butz¹, C. Mahnkopf¹, S. Busch¹
¹II. Medizinische Klinik - Kardiologie, Angiologie, REGIOMED-KLINIKEN GmbH, Coburg;
Aims Pulmonary vein isolation (PVI) is an effective strategy for atrial fibrillation treatment, but durability remains a matter of concern. Ablation index (AI) guided pulmonary vein isolation is widely used because of its approved safety and efficacy. Recently, there has been increasing interest in the high-power short-duration (HPSD) approach because it has shown a potential to shorten procedural and ablation times. However long-term results are lacking and durability of lesions is unknown. We aimed to evaluate the AI-values during HPSD ablation compared to low-power long-duration ablation (LPLD) PVI and to determine post-ablation scar on cardiac magnetic resonance imaging (MRI) after 3 months. Methods and results Thirty-six patients with paroxysmal or persistent atrial fibrillation underwent PVI. HPSD (60W/10 secs anterior, 60W/8 secs posterior, contact force 10-20g, HPSD group) was used in 26 patients and LPLD (30W/30 secs, contact force 10-20g, control group) in 10 patients. The mean AI values and scar for each segment were identified according to a 12-segment model. All patients underwent cardiac-MRI at 3 months, regardless of symptoms, to identify myocardial lesions (scar). No demographic differences were detected between the groups. The total AI values were higher in HPSD vs. LPLD (423±40 vs. 373±68, p<0.001). However, detectable scar was significantly lower in HPSD compared to LPLD (54% vs. 73%, p<0.001). Total AI value needed to determine scar was significantly higher in HPSD vs. LPLD (425±42 vs. 384±72 p<0.001), as well as for anterior (443±35 vs 415±56, p<0.001) and posterior (407±40 vs 347±71, p<0.001). Conclusion Despite reaching higher AI values with HPSD, less transmural lesions were detected in cardiac MRI 3 months post-ablation, compared to conventional ablation. A longer duration should be reconsidered using the HPSD strategy.
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