Background

Pulmonary vein isolation (PVI) in patients (pts) with paroxysmal (PAF) and persistent (persAF) atrial fibrillation is equally achievable and effective using a cryoballoon (Cryo) or radiofrequency (RF) catheter ablation (CA). The newly introduced high RF power short duration ablation (HPSD) technique has shown promising results in clinical trials. However, data comparing HPSD- to Cryo-PVI is sparse.

Objective

We sought to investigate success rates and procedural differences of HPSD-PVI vs. Cryo-PVI in patients undergoing ablation for PAF and persAF.

Methods

Between 01/2018 and 08/2021 all consecutive pts. undergoing de-novo PVI (HPSD or Cryo) were included in this analysis using specifically designed database. A power setting of 70W/7s (70W/5s at posterior wall) was considered as HPSD. For Cryo-PVI a 28mm balloon was used. Follow-up consisted of out-clinic pts visits, tele-consultation, 48h holter ECG and CIED interrogation if applicable.

Results

A total of 721 pts (46 HPSD, 675 Cryo) were analyzed. In all HPSD (n=46; 19 PAF [41%], 27 persAF [59%] and Cryo pts (n=675; 252 PAF [37%], 423 persAF [63%]) PVI was successfully achieved. Procedure duration was significantly longer for HPSD (108±35min vs. 77±26min, p<0.01) as compared to Cryo. Fluoroscopy time (HPSD 14±5min and Cryo 14±7min; p=1) and dose (HPSD: 3798±2460mGy*cm²; Cryo: 3199±4138mGy*cm²; p=0.333) was comparable in both groups. No major complications occurred in the HPSD group whereas for Cryo in 25 (3.7%; p=0.296) pts complications occurred (16 groin bleedings, 7 transient phrenic nerve palsies, 2 tamponades [1 lethal]).

At a follow-up of 290±135 days significantly more pts were free from any atrial arrhythmia after a single procedure using HPSD (38 HPSD [82.6%] vs. 458 Cryo pts [67.9%]; p=0.047).

Conclusion

Pulmonary vein isolation using HPSD is equally effective and safe to Cryoballoon-PVI in patients with PAF and persAF. This analysis revealed a significantly higher arrhythmia free survival after HPSD as compared to Cryo with low complication rates in this relatively small HPSD cohort. The procedure duration for Cryo was significantly shorter. Currently a prospective trial is conducted to corroborate these findings.