Background: Circumferential pulmonary vein isolation (PVI) using High-Power Short-Duration (HPSD) radiofrequency energy has become a standard treatment for patients with atrial fibrillation (AF), with promising clinical results. However, point-by-point ablation is often time-intensive, and pulmonary vein (PV) reconnections are frequently observed. Very High-Power Short-Duration (vHPSD) ablation, applying 90W for 4 seconds, aims to provide a faster and more effective approach with minimal complication rates.

Objective: Our study aimed to compare procedural duration, complication rates, and short-term efficacy after 3-months in patients receiving ablation for AF with HPSD (50W/10s) and vHPSD (90W/4s).

Methods: We enrolled 267 consecutive patients with persistent or paroxysmal AF who underwent de novo PVI at our center between 2019 and 2023. We compared a power setting of 50W for 10 seconds (HPSD, n=202) with a very high-power protocol of 90W for 4 seconds (vHPSD, n=65). In case of severe fibrotic substrate additional ablation lines were placed and cavotricuspid isthmus ablation was performed if atrial flutter was detected. he procedure time, complication rate, as well as the recurrence rate after 3 months, were recorded.

Results: Baseline characteristics were comparable between the groups. The mean procedure time in the vHPSD group (89.49 min) was significantly lower than the HPSD group (115 min) (P<0.01). Entry and exit block were achieved in all patients. In the HPSD group, we encountered 1 case of pericardial tamponade necessitating interventional treatment (0.49%), and 2 cases of aneurysm spurium managed conservatively (0.98%). Additionally, there were 2 cases of post-interventional pericarditis in the HPSD group (0.98%) and 1 in the vHPSD group (1.53%). Recurrence rates after 3 months did not significantly differ between the groups (HPSD 17.73% and vHPSD 9.68%, p=0.31).