Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation

Salló, Zoltán; Perge, Péter; Balogi, Bernadett; Orbán, Gábor; Piros, Katalin; Herczeg, Szilvia; Nagy, Klaudia Vivien; Osztheimer, István; Ábrahám, Pál; Merkely, Béla; Gellér, László; Szegedi, Nándor

doi:10.3389/fcvm.2022.935705

Cited by 12 publications

(26 citation statements)

References 39 publications

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“…In a similar study, Salló et al compared 30, 50, and 90 W approaches 14 . The investigators reported similar FPI rates between 50 and 90 W (78% vs. 80%).…”

Section: Clinical Outcomes With 90 W Ablationmentioning

confidence: 96%

Clinical outcomes with very high power very short duration ablation for atrial fibrillation: The jury is still out

Calvert

Gupta

2022

Cardiovasc electrophysiol

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While the landscape of atrial fibrillation (AF) ablation is changing rapidly, radiofrequency (RF) remains the current gold standard. Approaches such as very high power, very short duration (vHPvSD) ablation, using 90 W 4 s lesions, attempts to improve safety outcomes by altering the lesion profile such that damage to surrounding noncardiac structures is potentially minimized. 1,2 It is reasonable to assume that ablation and procedural times are also likely to be improved. However, these benefits are likely to be more relevant if clinical outcomes with vHPvSD are at least noninferior to standard RF ablation. Is this the case?We recently reviewed data from initial vHPvSD studies showing somewhat disappointing first pass isolation (FPI) and acute reconnection rates compared with standard RF ablation (sRF). 3 It is important to note that whilst these parameters are excellent acute markers for clinical efficacy, they are not a substitute for clinical outcome data on follow up. In this edition of the Journal of Cardiovascular Electrophysiology, Mueller and colleagues present the results of a single center, retrospective, propensity matched study comparing 12-month outcomes of ablation with 90 W (vHPvSD)versus Ablation Index (AI) guided 50 W (sRF) in 84 patients. 4 They found that 90 W vHPvSD ablation was associated with shorter ablation times (10.5 vs. 17.4 min; p = .001), but with lower FPI rates (40% vs. 62%; p = .049), higher AF recurrence during the blanking period (38% vs. 12%; p = .007), and a trend towards a lower freedom from AF at 12 months (62% vs. 75%; p = .071).

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“…In a similar study, Salló et al compared 30, 50, and 90 W approaches 14 . The investigators reported similar FPI rates between 50 and 90 W (78% vs. 80%).…”

Section: Clinical Outcomes With 90 W Ablationmentioning

confidence: 96%

Clinical outcomes with very high power very short duration ablation for atrial fibrillation: The jury is still out

Calvert

Gupta

2022

Cardiovasc electrophysiol

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“…Thus, the final analysis included 29 studies 8,24–51 (3 randomized studies and 26 observational studies), analyzing 9721 patients. vHPSD ablation was performed in five studies (four studies with 90‐W ablation and one study with 70‐W ablation).…”

Section: Resultsmentioning

confidence: 99%

Network meta‐analysis and systematic review comparing efficacy and safety between very high power short duration, high power short duration, and conventional radiofrequency ablation of atrial fibrillation

Tokavanich

Prasitlumkum

Kewcharoen

et al. 2023

Cardiovasc electrophysiol

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Background High‐power short‐duration (HPSD) atrial fibrillation (AF) ablation with a power of 40–50 W was proved to be safe and effective. Very high‐power short‐duration (vHPSD) AF ablation is a novel method using >50 W to obtain more durable AF ablation. This study aimed to evaluate the efficacy and safety of vHPSD ablation compared with HPSD ablation and conventional power ablation. Methods A literature search for studies that reported AF ablation outcomes, including short‐term freedom from atrial arrhythmia, first‐pass isolation (FPI) rate, procedure time, and major complications, was conducted utilizing MEDLINE, EMBASE, and Cochrane databases. All relevant studies were included in this analysis. A random‐effects model of network meta‐analysis and surface under cumulative ranking curve (SUCRA) were used to rank the treatment for all outcomes. Results A total of 29 studies with 9721 patients were included in the analysis. According to the SUCRA analysis, HPSD ablation had the highest probability of maintaining sinus rhythm. Point estimation showed an odds ratio of 1.5 (95% confidence interval [CI]: 1.2–1.9) between HPSD ablation and conventional power ablation and an odds ratio of 1.3 (95% CI: 0.78–2.2) between vHPSD ablation and conventional power ablation. While the odds ratio of FPI between HPSD ablation and conventional power ablation was 3.6 (95% CI: 1.5–8.9), the odds ratio between vHPSD ablation and conventional power ablation was 2.2 (95% CI: 0.61–8.6). The procedure times of vHPSD and HPSD ablations were comparable and, therefore, shorter than that of conventional power ablation. Major complications were low in all techniques. Conclusion vHPSD ablation did not yield higher efficacy than HPSD ablation and conventional power ablation. With the safety concern, vHPSD ablation outcomes were comparable with those of other techniques.

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“…[5][6][7][8] These properties of vHPSD lesions raise a need for decreasing the interlesion distance, verified in a clinical setting by our previous report. 11 The advantages of this novel technique have also translated into clinically meaningful results in previous studies, as evidenced by substantially shorter total procedure, LA ablation, and radiofrequency times compared with ablation with lower power. 11,13 Our current study strongly underpins these findings, as procedures performed with 90 W were shorter than those with 50 W. Nevertheless, acute procedural efficacy outcome measures of vHPSD PVI have previously shown a huge variety; for example, first-pass isolation rates ranged from 18% to 80% and acute reconnection rates ranged from 27% to 32%.…”

Section: Vhpsd Pvimentioning

confidence: 90%

“…11 The advantages of this novel technique have also translated into clinically meaningful results in previous studies, as evidenced by substantially shorter total procedure, LA ablation, and radiofrequency times compared with ablation with lower power. 11,13 Our current study strongly underpins these findings, as procedures performed with 90 W were shorter than those with 50 W. Nevertheless, acute procedural efficacy outcome measures of vHPSD PVI have previously shown a huge variety; for example, first-pass isolation rates ranged from 18% to 80% and acute reconnection rates ranged from 27% to 32%. 10,11,13 Studies that showed low first-pass isolation and high acute reconnection rates used larger (<6 mm) inter-tag distance, which explains the difference from our current results.…”

Section: Vhpsd Pvimentioning

confidence: 90%

“…[5][6][7][8][9] Recently, a very HPSD (vHPSD; 90 W, 4 s) technique has been introduced, but initial efficacy results were mostly discouraging regarding first-pass isolation rates, acute reconnection rates, and arrhythmia-free survival. [10][11][12][13][14] We hypothesized that vHPSD PVI could result in similar acute and long-term efficacy as ablation indexguided PVI with 50 W. 11 Therefore, we designed the HPSD Remap study (Efficacy Comparison of High and Very High Power Short Duration Pulmonary Vein Isolation, URL: https://www.clinicaltrials.gov; unique identifier NCT05459831), in which durability of lesions was assessed by a repeat electrophysiology study after an index PVI performed with either a 90-or 50-W power setting.…”

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confidence: 99%

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Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study

Szegedi,

Salló,

Nagy

et al. 2024

Circ: Arrhythmia and Electrophysiology

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BACKGROUND: High-power short-duration ablation has shown impressive efficacy and safety for pulmonary vein isolation (PVI); however, initial efficacy results with very high power short-duration ablation were discouraging. This study compared the long-term durability of PVI performed with a 90 versus 50 W power setting. METHODS: Patients were randomized 1:1 to undergo PVI with the QDOT catheter using a power setting of 90 or 50 W. Three months after the index procedure, patients underwent a repeat electrophysiology study to identify pulmonary vein reconnections. Patients were followed for 12 months to detect AF recurrences. RESULTS: We included 46 patients (mean age, 64 years; female, 48%). Procedure (76 versus 84 minutes; P =0.02), left atrial dwell (63 versus 71 minutes; P =0.01), and radiofrequency (303 versus 1040 seconds; P <0.0001) times were shorter with 90W versus 50W procedures, while the number of radiofrequency applications was higher with 90W versus 50W (77 versus 67; P =0.01). There was no difference in first-pass isolation (83% versus 82%; P =1.0) or acute reconnection (4% versus 14%; P =0.3) rates between 90W and 50W. Forty patients underwent a repeat electrophysiology study. Durable PVI on a per PV basis was present in 72/78 (92%) versus 68/77 (88%) PVs in the 90W and 50W energy setting groups, respectively; effect size: 72/78−68/77=0.040, lower 95% CI=−0.051 (noninferiority limit=−0.1, ie, noninferiority is met). No complications occurred. There was no difference in 12-month atrial fibrillation-free survival between the 90W and 50W groups ( P =0.2). CONCLUSIONS: Similarly high rates of durable PVI and arrhythmia-free survival were achieved with 90W and 50W. Procedure, left atrial dwell, and radiofrequency times were shorter with 90W compared with 50W. The sample size is too small to conclude the safety and long-term efficacy of the high and very high-power short-duration PVI; further studies are needed to address this topic. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05459831.

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Impact of High-Power and Very High-Power Short-Duration Radiofrequency Ablation on Procedure Characteristics and First-Pass Isolation During Pulmonary Vein Isolation

Cited by 12 publications

References 39 publications

Clinical outcomes with very high power very short duration ablation for atrial fibrillation: The jury is still out

Clinical outcomes with very high power very short duration ablation for atrial fibrillation: The jury is still out

Network meta‐analysis and systematic review comparing efficacy and safety between very high power short duration, high power short duration, and conventional radiofrequency ablation of atrial fibrillation

Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study

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