Very high-power short-duration using 70W and a flexible tip ablation catheter for pulmonary vein isolation: the POWER PULSE randomized controlled trial

Very high-power short-duration (vHPSD) was developed to optimize radiofrequency ablation for atrial fibrillation (AF). However, data on vHPSD ≥ 70W remains limited. We investigated acute efficacy, safety and long-term rhythm outcomes of vHPSD-70W in a randomized controlled trial.

A total of n = 200 patients with paroxysmal AF were randomly assigned 1:1 to receive pulmonary vein isolation (PVI) using vHPSD (70 W/5–7 s) or standard (30–40W, 20–40 s) ablation with a flexible, enhanced-irrigation tip catheter. Primary endpoint was the number of reconnected pulmonary veins (rPV) after adenosine testing. Secondary endpoints included first-pass isolation (FPI), silent cerebral lesions (SCLs) and rhythm outcomes on 12-month follow-up. Mean number of rPVs was 0.6 ± 0.8 vs. 0.8 ± 0.9 (P = 0.145) with vHPSD-70W vs. standard ablation. Bilateral FPI was 42.7% vs. 30.2% (P = 0.072), while FPI of left PVs was higher with vHPSD-70W (63.5% vs. 49.0%, P = 0.042). Procedure (107.7 ± 34.2 vs. 131.3 ± 42.2 min) and radiofrequency (15.1 ± 6.7 vs. 41.8 ± 18.3 min) duration were significantly lower with vHPSD-70W (P < 0.001). Silent cerebral lesions occurred in 1/25 (4.0%) vs. 3/22 (13.6%, P = 0.328). On 12-month follow-up, freedom from any atrial arrhythmia (76.0% vs. 66.7%, P = 0.171) was similar, while vHPSD-70W showed a lower incidence of atrial tachycardia (AT) recurrence (1.0% vs. 10.4%, P = 0.005).

Very high-power short-duration with 70 W/5–7 s was non-superior to standard ablation regarding acute PV reconnection and 12-month freedom from any atrial arrhythmia. However, vHPSD-70W achieved a higher FPI rate of left PVs with a shorter procedure duration and a comparable safety profile. AT recurrence was significantly less common with vHPSD-70W.