Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

One Year follow-up of high-power short duration with 50W for AF ablation
J. Müller1, K. Nentwich1, A. Berkovitz1, P. Halbfaß1, E. Ene1, K. Sonne1, I. Chakarov1, T. Deneke1
1Klinik für Kardiologie II / Interventionelle Elektrophysiologie, RHÖN-KLINIKUM AG Campus Bad Neustadt, Bad Neustadt a. d. Saale;


Background: 
Pulmonary vein isolation (PVI) using radiofrequency ablation is an effective treatment option for patients with atrial fibrillation (AF). Application of high power over a short period of time is reported to create more efficient lesions. This study aims to investigate the efficacy of high-power short-duration (HPSD) after one year of follow-up.

Methods: Consecutive patients undergoing AF ablation with HPSD (50W; ablation index-guided; target AI 350 for posterior wall ablation, AI 450 for anterior wall ablation) using the ThermoCool SmartTouch SF DF catheter (CARTO) were included. Periprocedural parameters and complications were recorded and analysed. First PVI and redo procedures as well as paroxysmal and persistent AF were compared. Short-term endpoints included intraprocedural reconnection of at least one PV after initial isolation and intrahospital AF recurrence; midterm endpoint AF freedom after 3 months, long-term endpoint AF freedom after 12 months.

Results: 
A total of 819 patients underwent AF ablation with HPSD (67  10 years; 57% male; 42% paroxysmal AF; 66% first PVI). Median procedure time was 81.8  24.6 minutes with ablation times of 16.3  9.6 minutes. Intraprocedural reconnection occurred in 18% and intrahospital AF recurrence in 8% (6% paroxysmal AF vs. 11% persistent AF; p=0.015). No difference among paroxysmal and persistent AF patients could be observed with 87% (p=0.707) freedom from AF recurrence after 3 months and 63% (p=0.539) after 12 months. Patients with first PVI revealed higher rates of sinus rhythm compared to redo procedures at 3 months (90% first PVI vs. 82% redo; p=0.004) and 12 months (70% first PVI vs. 52% redo; p=0.001). Using multivariable regression models presence of CAD, decreased LVEF and redo procedures were independent predictors for AF recurrence after 12 months.

Conclusions: Overall success rates after 3 and 12 months were 87% and 64%, respectively, with more favourable long-term results for patients with first PVI. No difference between paroxysmal and persistent AF could be observed. Significant predictors of AF recurrence during follow-up were presence of CAD, redo procedures and decreased LVEF. 


https://dgk.org/kongress_programme/jt2022/aV569.html