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

Vassallo, Fabrício; Meigre, Lucas Luis; Serpa, Eduardo; Lovatto, Carlos; Cunha, Christiano; Carloni, Hermes; Simões, Aloyr; Meira, Karla; Pezzin, Flávia; Lacerda, Orly; Batista, Walter; Nogueira, Alberto; Amaral, Dalton

doi:10.24207/jca.v33i3.3406

Cited by 3 publications

(4 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this very small sample-sized study, we did not see any stroke or major bleeding in patients after procedure. Even the rate of AF recurrence was very low in our study combining with our previous publications using the HPSD technique 29,30 . The LAA, among other non-pulmonary vein triggers, has been reported to be an effective adjuvant ablation target 31 .…”

Section: Discussionsupporting

confidence: 67%

Initial Experience and Results of Combined Treatment for Atrial Fibrillation: Catheter Ablation with High-Power Short Duration Ablation and Left Atrial Appendage Closure

Vassallo¹,

Serpa²,

Walker³

et al. 2021

J Cardiac Arrhtythmias

Self Cite

View full text Add to dashboard Cite

Introduction: Long-term freedom from atrial fibrillation (AF) after catheter ablation and, consequently, the potential for stroke reduction remain unpredictable. Recently, left atrial appendage closure (LAAC) became an effective mechanical alternative to oral anticoagulation (OAC) for stroke prevention in AF patients. Objective: This study aims to evaluate the feasibility and safety of combined treatment for AF with catheter ablation (CA) with the high-power short duration technique associated with LAAC in one single procedure. Methods: Patients with non-valvular AF who underwent combined CA and LAAC procedure were included in the retrospective observational study. Between April 2018 and October 2020, 13 patients with AF were included, eight (61,54%) males, eight (61.54%) with persistent AF (PersAF), mean age 68.54 (65–84) years old, mean time from AF diagnosis to treatment 13.08 (3–33) months, mean CHA2VASC2 5.08 (3–7), all patients with coronary or vascular disease, 12 (92.31%) with hypertension, five (38.46%) with left ventricular dysfunction, four (30.77%) prior strokes using OAC and four (30.77%) patients with diabetes. Indications for LAAC included history of contraindication to OAC because of severe bleeding in eight (61.54%), previous stroke in four (30.77%) and two (13.08%) patients with LAA thrombus, despite the use of two different OAC (one associated with bleeding). One patient had a pseudoaneurysm in femoral artery, and two patients died of non-procedure complications after 30 days. At six months, angiotomography showed successful complete sealing of the LAA in seven (77.72%) of nine patients evaluated, and the two patients without it had a leak of less than 2 mm. After mean follow-up of 14 months (five to 33), 10 (90.91%) of the 11 patients were in sinus rhythm. Three (27.27%) patients, one in blanking period, recovered sinus rhythm after amiodarone. No cardioembolic or bleeding events occurred. Conclusion: In this small observational study, we showed the feasibility and safety of the combined therapy with AF catheter ablation with LAAC with a high rate of sinus rhythm and no cardioembolic event.

show abstract

Section: Discussionsupporting

confidence: 67%

Initial Experience and Results of Combined Treatment for Atrial Fibrillation: Catheter Ablation with High-Power Short Duration Ablation and Left Atrial Appendage Closure

Vassallo¹,

Serpa²,

Walker³

et al. 2021

J Cardiac Arrhtythmias

Self Cite

View full text Add to dashboard Cite

show abstract

“…The PVI procedure time was also decreased significantly with HP (50 W) ablation in a study by Bunch et In addition, this group also found that RF application time was lower in the HPSD group [16 (14-18) min vs. 26 (22)(23)(24)(25)(26)(27)(28)(29)(30) min; p < 0.001]. The vHPSD ablation technique (90 W, 4 s) was evaluated first in the QDOT-Fast clinical trial, resulting in a substantially shorter total procedure, ablation, and RF application times compared with previous studies (27).…”

Section: Procedural Characteristics With High-power Short-duration Ab...mentioning

confidence: 82%

“…We know from previous studies that FPI is an important predictor of long-term success rate (13)(14)(15). Vassallo et al (24) investigated patients who underwent AF ablation with HP (50 W on the anterior wall and 45 W elsewhere in the left atrium) or LP (20 W on the posterior wall, 30 W elsewhere) RF ablation power settings. Bilateral FPI was increased significantly with HPSD ablation compared to the LPLD patients (87.32 vs. 23.29%, p < 0.00001), which also resulted in a higher success rate at 12 months (87.32 vs. 67.12%, p < 0.0039).…”

Section: Procedural Characteristics With High-power Short-duration Ab...mentioning

confidence: 99%

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

Salló

Perge

Balogi

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

IntroductionHigh-power short-duration (HPSD) radiofrequency ablation has been proposed to produce rapid and effective lesions for pulmonary vein isolation (PVI). We aimed to evaluate the procedural characteristics and the first-pass isolation (FPI) rate of HPSD and very high-power short-duration (vHPSD) ablation compared to the low-power long-duration (LPLD) ablation technique.MethodsOne hundred fifty-six patients with atrial fibrillation (AF) were enrolled and assigned to LPLD, HPSD, or vHPSD PVI. The energy setting was 30, 50, and 90 W in the LPLD, HPSD, and vHPSD groups, respectively. In the vHPSD group, 90 W/4 s energy delivery was used in the QMODE+ setting. In the other groups, ablation index-guided applications were delivered with 30 W (LPLD) or 50 W (HPSD).ResultsBilateral PVI was achieved in all cases. Compared to the LPLD group, the HPSD and vHPSD groups had shorter procedure time [85 (75–101) min, 79 (65–91) min, and 70 (53–83) min], left atrial dwelling time [61 (55–70) min, 53 (41–56) min, and 45 (34–52) min], total RF time [1,567 (1,366–1,761) s, 1,398 (1,021–1,711) s, and 336 (247–386) s], but higher bilateral FPI rate (57, 78, and 80%) (all p-values < 0.01). The use of HPSD (OR = 2.72, 95% CI 1.15–6.44, p = 0.023) and vHPSD (OR = 2.90, 95% CI 1.24–6.44, p = 0.014) ablation techniques were associated with a higher probability of bilateral FPI. The 9-month AF-recurrence rate was lower in case of HPSD and vHPSD compared to LPLD ablation (10, 8, and 36%, p = 0.0001). Moreover, the presence of FPI was associated with a lower AF-recurrence rate at 9-month (OR = 0.09, 95% CI 0.04–0.24, p = 0.0001).ConclusionOur prospective, observational cohort study showed that both HPSD and vHPSD RF ablation shortens procedure and RF time and results in a higher rate of FPI compared to LPLD ablation. Moreover, the use of HPSD and vHPSD ablation increased the acute and mid-term success rate. No safety concerns were raised for HPSD or vHPSD ablation in our study.

show abstract

“…Furthermore, PV reconnection rate in the second procedures ( n = 78) was significantly lower in the PVs that had achieved first‐pass isolation in the first procedures than that in others (34% vs. 73%, p < .0001). In a previous work from our own lab, 20 in a retrospective analysis of 144 patients, the FPI effect can be used as a prediction factor for long‐term success since 85.92% of patients submitted to HPSD ablation reached this objective and had at 12 months 87.32% of patients, maintained sinus rhythm, while in LPLD patients 23.29% of patients achieved FPI and 67.12% were in sinus rhythm.…”

Section: Discussionmentioning

confidence: 99%

Reduced esophageal heating in high‐power short‐duration atrial fibrillation ablation in the contact force catheter era

Vassallo¹,

Meigre²,

Serpa³

et al. 2021

Pacing Clinical Electrophis

Self Cite

View full text Add to dashboard Cite

Background Atrial fibrillation (AF) ablation is alternative treatment to medical therapy. Most feared complication is atrioesophageal fistula Methods Observational, retrospective analysis of consecutive 355 patients undergoing first AF ablation. Low‐power long‐duration (LPLD) group contained 158 patients, with 121 (76.58%) having paroxysmal AF who underwent ablation with power 20/30W (anterior and posterior left atrial wall), 17 mL/min flow, and a contact force of 10–30 g for 30 s. High‐power short‐duration group (HPSD) contained 197 patients, with 113 (57.36%) having paroxysmal AF who underwent ablation at 45/50W of power with a contact force of 8–15 g/10–20 g and a 35 mL/min flow rate for 6–8 s on the anterior and the posterior left atrial wall, respectively. Both groups had pulmonary veins isolated and atrial flutter was ablated when needed. For patients not in sinus rhythm, cardioversion was performed before ablation Results There were no complications. LPLD group: Left atrial time 118.74 min, total 145.32 min, radiofrequency time 4317.99s, X‐ray 13.42 min, and elevation of luminal esophageal temperature (LET) in 132 (84.53%) patients. HPSD group: Left atrial time 72.16 min, total 93.76 min, radiofrequency time 1511.29s, X‐ray 7.6 min, and LET elevation in only 75 (38.07%) patients. A markedly higher rate of first‐pass isolation was observed in HPSD compared to LPLD, 77.16% versus 13.29%, respectively. Recurrence occurred in 64 (40.50%) and 32 (16.24%) in 28.45 and 22.35 months in LPLD and HPSD patients, respectively. In LPLD, 10 patients were submitted to endoscopy, and one (10%) had mild erythema and in HPSD, 13 performed the endoscopy, with two (15.38%) patients showing mild erythema Conclusion HPSD technique compared to the LPLD technique showed significant reduced radiofrequency and fluoroscopy times, higher rate of first‐pass isolation, lower recurrence rate, and esophageal temperature elevation and may also have a protective effect avoiding incidental esophageal injury due to these findings.

show abstract

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

Cited by 3 publications

References 31 publications

Initial Experience and Results of Combined Treatment for Atrial Fibrillation: Catheter Ablation with High-Power Short Duration Ablation and Left Atrial Appendage Closure

Initial Experience and Results of Combined Treatment for Atrial Fibrillation: Catheter Ablation with High-Power Short Duration Ablation and Left Atrial Appendage Closure

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

Reduced esophageal heating in high‐power short‐duration atrial fibrillation ablation in the contact force catheter era

Contact Info

Product

Resources

About