Multicenter prospective comparison of conventional and high-power short duration radiofrequency application for pulmonary vein isolation: the high-power short-duration radiofrequency application for faster and safer pulmonary vein ablation (POWER FAST III) trial

Castrejón‐Castrejón, Sergio; Cossiani, M Martinez; Jáuregui-Abularach, Miguel E.; Sola, Nuria Basterra; Criado, José Luis Ibáñez; Asensi, Joaquín Osca; Roca‐Luque, Ivo; Mitjans, Àngel Moya; Dorador, Aurelio Quesada; Olivares, Víctor M. Hidalgo; Castellano, Nicasio Pérez; Gómez, Juan Manuel; Macías-Ruiz, María Rosa; Villanueva, B. Bochard; Bada, Nerea Gonzalo; Prieto, Amador; López, Leonardo Elías Guido; Maldonado, María Eugenia Martínez; Hermida-Merino, Daniel; Cervantes, C. Escobar; Merino, José Luís

doi:10.1007/s10840-023-01509-9

Cited by 9 publications

(6 citation statements)

References 40 publications

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“…In the context of HPSD the recently presented POWERFAST‐III trial by Castrejón et al has to be discussed. This trial showed a nearly 60% rate of silent brain ischemia in the VHPSD arm (70 W 10 s) 30 . Although these finding are worrisome one should point out that the used catheter might not have been ideal for the use of VHPSD.…”

Section: Discussionmentioning

confidence: 88%

Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Wörmann,

Schipper,

Lüker

et al. 2023

Cardiovasc electrophysiol

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BackgroundThe newly introduced nonthermal pulsed field ablation (PFA) is a promising technology to achieve fast pulmonary vein isolation (PVI) with high acute success rates and good safety features. However, previous studies have shown that very high power short duration ablation (VHPSD) is also highly effective and fast to achieve PVI with potentially less arrhythmia recurrence compared to conventional radiofrequency ablation. Data comparing PFA to VHPSD‐PVI is lacking.ObjectiveThis study compared procedural and outcome data for PFA‐PVI to VHPSD‐PVI in patients with paroxysmal or persistent atrial fibrillation (PAF/persAF).MethodsConsecutive patients undergoing de novo PVI (PFA or VHPSD) were included in this analysis. For PFA‐PVI a pentaspline 20 electrode catheter was used. For VHPSD‐PVI an enhanced irrigated catheter with a power setting of 70 W/7 s (70 W/5 s at posterior wall) was employed in conjunction with electro‐anatomical mapping. All procedures were performed in deep analgo‐sedation.ResultsA total of n = 114 patients (n = 57[50%] PFA, n = 17[30%] PAF; n = 40[70%] persAF) were included in this analysis. PVI was successful in all patients. The PFA group revealed a significantly shorter procedure duration (65 ± 17 min vs. 95 ± 23 min, p < 0.01) but longer fluoroscopy time (PFA 15 ± 5 min and VHPSD 12 ± 3 min; p < 0.001). At follow‐up after median 125 days (interquartile range: 109–162) n = 46 PFA (80.7%) and n = 44 VHPSD pts (77.2%) were free from atrial arrhythmia after a single procedure (p = 0.819).Two tamponades occurred in the PFA while in VHPSD two pts suffered groin bleedings. One clinically nonsignificant PV stenosis occurred in the VHPSD group.ConclusionPulsed‐field ablation and VHPSD‐PVI seem to be highly effective and safe to achieve PVI in the setting of PAF and persAF with comparable arrhythmia‐free survival. However, procedure duration for PFA PVI is significantly shorter and therefore may be of potential benefit. Compared to PFA VHPSD‐PVI might ensure information on left atrial substrate allowing to target concomitant secondary tachycardias.

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Section: Discussionmentioning

confidence: 88%

Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Wörmann,

Schipper,

Lüker

et al. 2023

Cardiovasc electrophysiol

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“…In a prospective randomized trial, HPSD (70 W for 9–10 s) RF ablation for PVI was associated with significantly higher rate of MRI-detected subclinical strokes when compared with conventional AI-guided (25–40 W) ablation. 602 Another smaller RCT comparing high vs. standard power RF ablation for PVI also demonstrated a trend towards more asymptomatic cerebral emboli with HPSD ablation. 1212 …”

Section: Complicationsmentioning

confidence: 96%

“… 600 Furthermore, power-controlled ablation at 70 W over 5–7 s is associated with significantly greater procedural efficiency, fewer AF recurrences, and a similar safety profile to conventional power protocol (30–40 W for 20–40 s). 601 , 602 The absence of use of AI or LSI to standardize the lesion set in these latter studies may limit the reproducibility of the results. Care should be exercised using higher power at the posterior wall due to potential inadvertent overshoot and ‘heat stacking’ when applying consecutive lesions in close proximity, although it is also possible that a high-power short-duration (HPSD) protocol may be safer over the esophagus due to less depth of penetration ( Section 11.3.1 .).…”

Section: Mapping and Ablation Tools For Atrial Fibrillation Catheter ...mentioning

confidence: 99%

2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation

Tzeis,

Gerstenfeld,

Kalman

et al. 2024

Europace

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In the last three decades, ablation of atrial fibrillation (AF) has become an evidence-based safe and efficacious treatment for managing the most common cardiac arrhythmia. In 2007, the first joint expert consensus document was issued, guiding healthcare professionals involved in catheter or surgical AF ablation. Mounting research evidence and technological advances have resulted in a rapidly changing landscape in the field of catheter and surgical AF ablation, thus stressing the need for regularly updated versions of this partnership which were issued in 2012 and 2017. Seven years after the last consensus, an updated document was considered necessary to define a contemporary framework for selection and management of patients considered for or undergoing catheter or surgical AF ablation. This consensus is a joint effort from collaborating cardiac electrophysiology societies, namely the European Heart Rhythm Association, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society, and the Latin American Heart Rhythm Society .

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“…22,23 In a trial conducted by Kurose et al, the number of visual gaps observed in late gadolinium enhancement MRI after CBA was even higher than that after conventional RFA, suggesting potential advantages in outcome parameters associated with HPSD compared to CBA. 24 Additionally, in a study by Pak et al, the CBA group consisted of 11 patients who required a touch-up RFA (none in the HPSD group), predominantly targeting the right inferior PV ostium. These PV potentials were not detected during spiral catheter mapping but were successfully identified through circular catheter mapping.…”

Section: Procedures Efficacymentioning

confidence: 99%

Meta‐analysis of high‐power short‐duration versus cryoballoon ablation for atrial fibrillation

Lin,

Huang,

Huang

et al. 2024

Pacing Clinical Electrophis

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BackgroundThe existing literature regarding the treatment strategy for high‐power short‐duration (HPSD) ablation in patients diagnosed with atrial fibrillation (AF) is currently insufficient. The objective of this study is to perform a comparative analysis evaluating the effectiveness, safety, and procedural efficiency of HPSD versus cryoballoon ablation (CBA) for AF.MethodsA comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov databases to identify trials comparing HPSD with CBA for AF from their inception until December 25, 2023. Treatment effect measures were expressed as odds ratio (OR), mean difference (MD), accompanied by a 95% confidence interval (CI).ResultsThe analysis comprised six eligible trials involving a total enrollment of 2481 patients. No statistically significant disparities were observed in recurrent atrial arrhythmia (OR 0.90; 95% CI, 0.71–1.16) or total complications (OR 0.65; 95% CI, 0.38–1.12) between the two ablation techniques examined in this study. However, HPSD technique exhibited a significantly prolonged procedure time (MD 27.42; 95% CI, 19.03 to 35.81). Conversely, no significant differences were observed between the two modalities in terms of total fluoroscopy duration (MD −4.37; 95% CI −10.70 to 1.96) and ablation time (MD 7.95; 95% CI −3.97 to 19.88). Furthermore, HPSD demonstrated significantly higher odds of extrapulmonary vein (PV) trigger ablation compared to CBA (OR 18.86; 95% CI, 5.12–69.49). The subgroup analyses revealed that CBA continued to exhibit superior procedure time (except for the paroxysmal AF subgroup: [MD 29.52; 95% CI −4.25 to 63.60]), while no significant differences in safety and efficacy (except for the HPSD ≥ 70 W subgroup: [OR 0.44, 95% CI 0.20–0.97]) outcomes were still observed.ConclusionAmong patients undergoing ablation therapy for AF, both HPSD and CBA demonstrate comparable efficacy and safety profiles; however, HPSD is associated with longer procedural time and higher rates of extra‐PV trigger ablation.

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Multicenter prospective comparison of conventional and high-power short duration radiofrequency application for pulmonary vein isolation: the high-power short-duration radiofrequency application for faster and safer pulmonary vein ablation (POWER FAST III) trial

Cited by 9 publications

References 40 publications

Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

Comparison of pulsed‐field ablation versus very high power short duration‐ablation for pulmonary vein isolation

2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation

Meta‐analysis of high‐power short‐duration versus cryoballoon ablation for atrial fibrillation

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