Abstract 630 Very high-power short-duration ablation for pulmonary vein isolation utilizing a very-close protocol

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Very high-power short-duration ablation for pulmonary vein isolation utilizing a very-close protocol - The FAST and FURIOUS PVI study
C.-H. Heeger¹, S. Popescu¹, M. Feher², C. Eitel¹, B. Kirstein¹, A. Traub³, S. Hatahet², H. L. Phan³, J. Vogler¹, K.-H. Kuck⁴, R. R. Tilz¹
¹Klinik für Rhythmologie, Universitätsklinikum Schleswig-Holstein, Lübeck; ²Med. Klinik II / Kardiologie, Elektrophysiologie, Universitätsklinikum Schleswig-Holstein, Lübeck; ³Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; ⁴Kardiologie, LANS Cardio Hamburg, Hamburg;
Background: Very high-power short-duration (vHP-SD) radiofrequency (RF) ablation concept of atrial fibrillation (AF) treatment by pulmonary vein isolation (PVI) aims for safer, more effective and faster procedures. Utilizing conventional ablation applying the so-called “close-protocol” has been verified. Since lesion formation of vHP-SD ablation creates wider, but shallower lesions, we adapted the close-protocol to an individualized and tighter “very close-protocol” with a 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. We evaluated the safety and efficacy of vHP-SD ablation for PVI utilizing a very close-protocol in comparison to standard ablation. Methods and Results: A total of 50 consecutive patients with symptomatic AF were treated with a very-close protocol utilizing vHP-SD (vHP-SD group, Figure 1). This patient population was compared to 50 consecutive patients treated by an ablation-index (AI) guided strategy (control group). The mean RF time was 352 ± 81 (vHP-SD) and 1657 ± 570 seconds (control, p<0.0001), the mean procedure duration was 59 ± 13 (vHP-SD) and 101 ± 38 minutes (control, p<0.0001). First pass isolation rate was 74 % (vHP-SD) and 76 % (control, p=0.817). Severe adverse events were reported in 1 (2 %, vHP-SD) and 3 (6 %, control) patients (p=0.307). Twelve-month recurrence free survival was 78 % (vHP-SD) and 64 % (control, p=0.142). PVI durability assessed during redo procedures was 75 % (vHP-SD) vs. 33 % (control, p<0.001). Conclusions: Compared to AI guided ablation very close vHP-SD PVI showed a significantly shorter procedure and ablation time while efficacy and safety were comparable/similar between both ablation techniques. Figure 1: Final lesions set Three-dimensional electroanatomic reconstruction (CARTO 3, UNIVIEW module, Biosense Webster) of the left atrium in posterior anterior (left) and anterior posterior (right) view. Please note the two circles of very-high power short duration applications by 90 Watts/4 seconds (QMODE+ mode, red-white tags) encircling the right and left pulmonary veins.
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