Comparison of clinical and procedural outcomes between high‐power short‐duration, standard‐power standard‐duration, and temperature‐controlled noncontact force guided ablation for atrial fibrillation

Abstract

Introduction High‐power short‐duration (HPSD) ablation is a novel strategy using contact force‐sensing catheters optimized for power‐controlled radiofrequency ablation for atrial fibrillation (AF). This study investigates the outcomes of HPSD (50 W delivered for up to 15 s, Lesion Size Index of 5–6) compared to standard‐power standard‐duration (SPSD) (20–25 W until 400–500 gram seconds, up to 60 s) and temperature‐controlled noncontact (TCNC) (20‐40 W up to 60 s of ablation) settings. Methods We studied consecutive cases of patients with AF undergoing pulmonary vein isolation with TCNC, SPSD, and HPSD between January 7th, 2013 and January 11th, 2019. Procedural data collected include time to isolate the left (LPVT) and right pulmonary veins (RPVT), total ablation time (TAT), and radiofrequency ablation delivery time (RADT). Clinical data collected include sinus rhythm maintenance postprocedure. Results One hundred and seventy‐one patients were studied (44 TCNC, 51 SPSD, 76 HPSD). RADT was shorter when comparing HPSD to SPSD (25 vs. 41 min; p < .01), HPSD to TCNC (25 vs. 76 min; p < .01), and SPSD to TCNC groups (41 vs. 76 min; p < .01). TAT, LPVT, and RPVT were reduced between HPSD versus SPSD, HPSD versus TCNC, and SPSD versus TCNC groups, respectively (p < .01). There was no difference in sinus rhythm maintenance by Kaplan–Meier survival analysis (log rank test p = .12), after 3 or 12 months between groups overall, and when stratified by AF type, left atrial volume, CHA2DS2‐VASc score, or left ventricular ejection fraction. Conclusion AF ablation with HPSD reduced procedure times with similar sinus rhythm maintenance compared to SPSD and TCNC.

Comparison between High-Power Short-Duration and Conventional Ablation Strategy in Atrial Fibrillation: An Updated Meta-Analysis

“…Esophageal injuries correlated with PVI RFA occurred in 3 studies [ 21 , 32 , 37 ], while other 7 studies did not report any PVI-related esophageal injury during or after surgery [ 7 , 8 , 20 , 22 , 25 , 30 , 34 ]. The overall effect did not show statistically differences between HPSD and conventional ablation setting groups on esophageal injuries (RR = 0.99, 95% CI: 0.31-3.13, I 2 = 0%, and P = 0.98) ( Figure 4(a) ).…”

High-power short-duration versus standard-power standard-duration settings for repeat atrial fibrillation ablation

“…Antiarrhythmic drugs except amiodarone were stopped 3 days prior to the procedure. We have previously described our ablation protocol in separate studies [ 15 , 16 ]. Briefly, femoral venous access was obtained, then a multipolar catheter was placed in the coronary sinus.…”

“…To our knowledge, there are no studies directly comparing HPSD versus SPSD settings in patients presenting for repeat ablation with AF recurrence after initial ablation. Previously, we compared clinical and procedural outcomes between temperature-controlled non-contact force (TCNC), SPSD, and HPSD settings at our institution [ 15 , 16 ]. In this report, we compared the long term clinical and procedural outcomes between HPSD and SPSD for repeat ablation in those with AF recurrence after initial AF ablation.…”

Irrigated DiamondTemp catheter and return to ablation under temperature control. First Polish experience with DiamondTemp catheter in pulmonary vein isolation.

“…In the recent years there has been a technological breakthrough in the field of atrial fibrillation (AF) ablation due to the introduction of the ablation with high-power and short-duration [1][2][3][4][5][6][7][8][9]. In classical ablation, thermal injury occurs in two phases: resistive and conductive, with the second one being the dominant mechanism.…”

“…Thus, the depth of permanent injury is more predictable, and the risk of collateral tissue damage is reduced. High-power ablations are classified as those performed with a power of ≥ 50 W [1][2][3][4][5][6][7][8][9].…”