Abstract 824 Safety of high-power short-duration compared to conventional ablation in a large cohort of patients with atrial fibrillation

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Safety of high-power short-duration compared to conventional ablation in a large cohort of patients with atrial fibrillation
M.-A. Popa¹, M. Kottmaier¹, F. Bourier¹, S. Lengauer¹, M. Telishevska¹, K. Wimbauer¹, L. V. Förschner¹, H. Krafft¹, S. J. Maurer¹, E. Risse¹, F. Bahlke¹, F. Englert¹, S. Dorfmeister¹, S. Kathan¹, T. Reents¹, G. Heßling¹, I. Deisenhofer¹
¹Elektrophysiologie, Deutsches Herzzentrum München, München;
Background: Pulmonary vein isolation (PVI) using power controlled high-power short-duration (HPSD) is becoming increasingly established as an ablation strategy for atrial fibrillation (AF). Besides shorter procedure times, HPSD ablation is associated with improved effectiveness as compared to conventional ablation. However, data about safety of power controlled HPSD ablation especially above 50 W remains limited. We sought to compare the rate of severe complications occurring within 30 days of PVI using either HPSD or conventional ablation in a large cohort of patients. Methods: We investigated 1134 consecutive patients with AF (38.3% paroxysmal, 61.7% persistent) who underwent initial catheter ablation at our hospital between January 2015 and March 2021. Circumferential PVI was performed using point-by-point lesions with an irrigated-tip ablation catheter either with conventional power (30-35 W for 20-30 seconds) or HPSD (50-70 W for 5-10 seconds). Additional substrate ablation was performed in patients with persistent AF. All patients underwent ablation on uninterrupted oral anticoagulation. Heparin was administered to achieve an intraprocedural activated clotting time of ≥300 seconds. Severe complications occurring within 30 days of ablation were assessed retrospectively. Results: Baseline characteristics were well balanced between groups (age 65.3 ± 11.2 years, 63.7% male). HPSD ablation was performed in 582 patients and conventional ablation in 552 patients. The rates of pericardial tamponade requiring pericardiocentesis (n=2 vs. n=1) and of pericardial effusion ≥10 mm without haemodynamic relevance (n=2 vs. n=1) were not significantly different between groups (both p=0.594). There was no significant difference in the incidence of transient ischaemic attacks (n=1 vs. n=2, p=0.532). No stroke, cardiac arrest, atrio-oesophageal fistula or death was observed in any group. Procedure duration (122.7 ± 51.0 min vs. 155.1 ± 50.3 min, p<0.001) and radiofrequency time (22.3 ± 19.1 min vs. 52.8 ± 22.0 min, p<0.001) were significantly shorter in the HPSD group. Conclusions: Pulmonary vein isolation using HPSD ablation is as safe as conventional ablation and is associated with a significantly reduced procedure duration and radiofrequency time.
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