Comparison of high‐power short‐duration (HPSD) ablation of atrial fibrillation using a contact force‐sensing catheter and conventional technique: Initial results

Abstract

Introduction: Atrial fibrillation (AFib) ablation is alternative treatment to drugs. Literature suggests that use of contact force (CF) catheter with higher power for short periods is effective and safe. Methods/Results: Retrospectively analyzed 76 patients undergoing the first ablation. Third five patients‐group A: 27 (77%) paroxysmal AFib (PAFib) and 8 (23%) persistent AFib (PersAFib) who underwent ablation at the power of 30 W‐17 mL/minute flow with a CF of 10‐30 g for 30 seconds. Fourty one patients‐group B: 28 (68.3%) PAFib and 13 (31.70%) PersAFib underwent ablation using 45 W on posterior wall with CF of 8/15 g, as well as 50‐W anterior wall with CF of 10/20 g‐35 mL/minute flow for 6 seconds. Pulmonary vein isolation in both groups and ablated. For patients not in the sinus, we performed cardioversion before ablation. No complications. Group A: Left atrial time 110 ± 29 minutes, total 148 ± 33.6 minutes, radiofrequency time (RF) 4558 ± 1998 seconds, X‐ray 8.5 ± 3.5 minutes, and elevation of esophageal temperature (ET) in 26 (74.3%). group B: Left atrial time 70.7 ± 18.5 minutes ( P < .00001), total 106 ± 23 minutes ( P < .00001), RF 1909 ± 675.8 seconds ( P < .00001), X‐ray 8.8 ± 6.6 minutes ( P = .221) and elevation of ET in 21 (51.20% ‐ P = .0578). In 6 and 12 months follow‐up, we had 9 (25.71%) and 11 (31.42%) recurrences in group A and 5 (12.19%) and 7 (17.07%) in group B ( P = .231 at 6 and P = .14 at 12 months), respectively. Conclusions: HPSD was safe, useful, and efficient compared with CT, and reduced procedural time and total RF time. HPSD may reduce esophageal injury because of lower heating rate and it may reduce the recurrence of atrial tachyarrythmias.

Safety and Efficacy of High Power Shorter duration Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis.

“…Additionally, fluoroscopy time was also shorter in the HPSD group, which had a direct favorable impact on the patient, operator, and supporting staff. These results were consistent with previously published findings 4,16,20,22,23,32 . A significant reduction in the procedural time was observed in the HPSD group because of shorter ablation time.…”

“…A significant difference in power delivery setting was found between the HPSD and LPLD groups. There is no consensus about the power and duration settings for HPSD, in our study, energy levels above 40 W are considered as high power and duration of application for 2˜10s as short duration 4,13,14,[17][18][19][20] . All patients received PVI, additional linear ablations were performed in select patients at the operator's discretion in some trials 4,18,19 .…”

The First-Pass Isolation Effect in High-Power Short-Duration Compared to Low-Power Long-Duration Atrial Fibrillation Ablation: a Predictor of Success

“…In the HPSD ablation technique, on the posterior wall, atrial roof, and atrial flutter (if indicated), the power of radiofrequency generator is set to 45 Watts for no more than 6 seconds. On the anterior wall, the power was increased to 50 Watts with an estimated pressure of 10-20 grams of contact force for short periods of time 16 . The irrigation pump was always programmed for 35mL/min regardless of the power setting.…”

The use of a high‐power (50 W), ablation index‐guided protocol for ablation of the cavotricuspid isthmus

“…4 In clinical practice, AI-guided pulmonary vein isolation (PVI) and left anterior line ablation show promising results. 3,5,6 One study using AI guidance for ablation of the CTI showed higher firstpass conduction block of the CTI despite fewer RF applications. 7 In the pursuit of optimized lesions, another current strategy is to increase power.…”