Comparing very high power short duration ablation and second generation cryoballoon ablation in patients with paroxysmal atrial fibrillation

Catheter ablations for atrial fibrillation (AF) are among the most commonly performed electrophysiological procedures worldwide. The thermal ablation techniques are using either radiofrequency (RF) or cryoablation. Recently, the "very-high-power, short-duration" (vHPSD) RF technique has been developed, delivering 90 Watts of power in a relatively short amount of time to create the ablation lesions. The aim of this study was to compare the vHPSD and cryoballoon (CB) catheter ablation techniques.

This single-center study included 148 patients with symptomatic, antiarrhythmic drug-refractory paroxysmal atrial fibrillation who underwent pulmonary vein isolation (PVI) at our university center between January 1, 2023, and September 30, 2024. Patients were treated with either vHPSD radiofrequency ablation (n=59) CB ablation (n=89). Procedural parameters and atrial fibrillation recurrence rates were prospectively analyzed over a 6-month follow-up period.

The vHPSD group showed a significantly shorter total procedural time (38.9 ± 7.9 minutes vs. 55.4 ± 13.8 minutes; p<0.001), fluoroscopy time (0 sec vs. 390 ± 153 sec, p<0.001), and radiation dose (0 mGy vs. 16.6 ± 26.1 mGy, p<0.001) compared to the CB group. No significant differences were found between the groups regarding recurrence rates at the 3-month (vHPSD: 9.83% vs. CB: 6.32%, p=0.46) and 6-month (vHPSD: 5.71% vs. CB: 6.67%, p=0.85) follow-up visits. One complication was reported in the CB group.

The vHPSD technique for catheter ablation provides the advantages of shorter total procedural time and lower radiation exposure compared to the CB technique in patients undergoing catheter ablation for paroxysmal AF, with similar short- and mid-term success rates.