Abstract 70 High power short duration compared to the CLOSE protocol for pulmonary vein isolation leads to improved procedural characteristics

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02302-4
High power short duration compared to the CLOSE protocol for pulmonary vein isolation leads to improved procedural characteristics
M. Forkmann¹, B. Tose Costa Paiva¹, M. N. Alachkar¹, S. Ivanyan¹, C. Schüller¹, S. Butz¹, C. Mahnkopf¹, S. Busch¹
¹II. Medizinische Klinik - Kardiologie, Angiologie, REGIOMED-KLINIKEN GmbH, Coburg;
Background: Compared to former ablation settings, using the CLOSE protocol for atrial ﬁbrillation (AF) ablation improved the acute effectiveness and outcome. Recently, there has been increasing interest in the high-power short-duration (HPSD) approach because it has shown potential to shorten procedural and ablation times. We sought to investigate the procedural ablation process of CLOSE (group 1) compared to HPSD (group 2). Methods: The procedural data of 24 consecutive patients in whom a pulmonary vein isolation was guided by using the CLOSE protocol (anterior 35 W, AI ≥ 550 and posterior 28-30W, AI ≥ 400, interlesion distance 3-4 mm) were compared with 32 consecutive patients who were ablated by using a HPSD protocol (60W/10 secs anterior, 60W/8 secs posterior, contact force 10-20g, interlesion distance 5-6mm). Results: Baseline characteristics were almost comparable between both groups, except for the body mass index which was higher in group 1 (32 vs 28 kg/m², p= 0.044). The left atrial dwelling time was significantly lower in group 2 compared to group 1 (64 vs. 86 min, p<0.01). Ablation time and the number of radiofrequency application were also significantly lower (7.8 vs. 30.5 min, p<0.01; 49 vs. 65 min, respectively; p<0.01). No relevant difference could be detected in the acute first-pass isolation rates (group 1 vs. group 2; for right pulmonary veins: 83% vs. 71%, for left pulmonary veins 83% vs 68%, and 71% vs. 55% for both). Conclusion: Using of HPSD results in a distinct reduction of procedure and ablation times compared to the CLOSE protocol and seems not to have a negative impact on acute effectiveness in AF ablation.
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