Background: Very high-power short-duration (vHP-SD) radiofrequency (RF) ablation of atrial fibrillation (AF) by pulmonary vein isolation (PVI) aims for safer, more effective and faster procedures. vHP-SD ablation creates wider but shallower lesions. Utilizing an individualized “very close-protocol” of 3 – 4 mm inter-lesion distance (ILD) at the anterior and 5 – 6 mm ILD at the posterior aspect of the left atrium using vHP-SD only was adapted. Although acute efficacy for PVI was recently shown, no data on chronic PVI durability has been assessed up to date. Chronic PVI durability was evaluated during repeat electrophysiological procedures in patients after initial vHP-SD based PVI during repeat catheter ablation procedures in case of recurrence of AF, atrial tachycardia or left atrial appendage closure.

Methods and Results: A total of 25 consecutive patients with repeat left atrial procedures after initial vHP-SD based PVI were included in this study. The median time to the repeat procedure was 5 (IQR 2, 10) months. The patients received a repeat procedure and verification of PVI due to recurrence of AF (n=8), atrial tachycardia (n=12), typical flutter (n=1) or left atrial appendage closure (n=4). Verified PVI durability of all PVs was found in 16/25 (64 %) patients. PVI reconduction was found in 1 PV in 1 (4 %) of the patients, PVI reconduction was found in 2 PVs in 6 (24 %) patients and PVI reconduction was found in 3 PVs in 1 (4 %) patient. A total of 81/100 (81 %) PVs were found to be chronically isolated. For right sided PVs, 42/50 PVs (84 %) were isolated while for left sided PVs, 39/50 PVs (78 %) were isolated.  All PVs were reisolated utilizing radiofrequency energy.

Conclusions: PVI solely utilizing vHP-SD via a very close-protocol provides high rates of chronically isolated pulmonary veins.