Safety profile and long-term efficacy of very high-power short-duration (60–70 W) catheter ablation for atrial fibrillation: results of a large comparative analysis

Abstract

Aims This retrospective study sought to compare complication rates and efficacy of power-controlled very high-power short-duration (vHPSD) and conventional catheter ablation in a large cohort of patients with atrial fibrillation (AF). Methods and results We analyzed 1115 consecutive patients with AF (38.7% paroxysmal, 61.3% persistent) who received first-time catheter ablation at our centre from 2015 to 2021. Circumferential pulmonary vein isolation ± additional substrate ablation using an irrigated-tip catheter was performed with vHPSD (70 W/5–7 s or 60 W/7–10 s) in 574 patients and with conventional power (30–35 W/15–30 s) in 541 patients. Baseline characteristics were well-balanced between groups (mean age 65.1 ± 11.2 years, 63.4% male). The 30-day incidence of cardiac tamponade [2/574 (0.35%) vs. 1/541 (0.18%), P = 0.598], pericardial effusion ≥ 10 mm [2/574 (0.35%) vs. 1/541 (0.18%), P = 0.598] and transient ischaemic attack [1/574 (0.17%) vs. 2/541 (0.37%), P = 0.529] was not significantly different between vHPSD and conventional ablation. No stroke, atrio-esophageal fistula, cardiac arrest or death occurred. Procedure (122.2 ± 46.8 min vs. 155.0 ± 50.5 min, P < 0.001), radiofrequency (22.4 ± 19.3 min vs. 52.9 ± 22.0 min, P < 0.001), and fluoroscopy (8.1 ± 7.2 vs. 9.2 ± 7.4, P = 0.016) duration were significantly shorter in the vHPSD group. At 12 months follow-up, freedom of any atrial arrhythmia was 44.1% vs. 34.2% (P = 0.010) in persistent AF and 78.1% vs. 70.2% in paroxysmal AF (P = 0.068). Conclusion vHPSD ablation is as safe as conventional ablation and is associated with an improved long-term efficacy in persistent AF.

Catheter ablation of atrial fibrillation using FireMagic TrueForce ablation catheter: The TRUEFORCE trial

“…The most used CF‐sensing catheters for AF ablation today include SmartTouch or SmartTouch SF (Biosense Webster, Irvine, USA) and TactiCath catheter (Abbott, Illinois, USA). Previous large, randomized trials for treatment of AF using these catheters showed 100% successful acute PV isolation and treatment efficacy range of 66.4%–72.5% 6–9 . In the present study, the acute successful PVI isolation and rate of freedom from AF and other atrial arrhythmias at one year reached 100% and approximately 81%, respectively.…”

“…Previous large, randomized trials for treatment of AF using these catheters showed 100% successful acute PV isolation and treatment efficacy range of 66.4%-72.5%. [6][7][8][9] In the present study, the acute successful PVI isolation and rate of freedom from AF and other atrial arrhythmias at one year reached 100% and approximately 81%, respectively. The high effectiveness of the novel catheter is due to technological advances and may also be related to improved ablation strategies in recent years.…”

Acute oesophageal safety and long-term follow-up of AI-guided high-power short-duration with 50 W for atrial fibrillation ablation

“… 20 Recently, also very high-power short-duration (vHPSD) ablations with 60–70 W were found to be comparably safe and even more efficient than ablations with conventional power. 21 …”

Myocardial injury and inflammation following pulsed‐field ablation and very high‐power short‐duration ablation for atrial fibrillation

“…[5][6][7] HPSD is associated with a similar safety profile and with equivalent to improved long-term rhythm outcomes as standard RFA, while consistently reducing procedural duration. [7][8][9][10] PFA is a novel, nonthermal cardiac ablation modality using highvoltage electric fields to create nanoscale pores in the cell membrane through a mechanism known as irreversible electroporation. 11,12 Cell membrane disruption compromises cell homeostasis eventually leading to cell death.…”