Efficiency, efficacy and safety of very high-power short-duration radiofrequency atrial fibrillation ablation

Over the past few decades, atrial fibrillation (AF) catheter ablation has become an evidence-based, safe, and effective treatment. The procedure primarily focuses on pulmonary veins’ electrical isolation from the left atrium (LA), frequently using radiofrequency (RF) energy. Very high-power short-duration (vHPSD) RF applications can improve lesion quality and reduce procedural time compared to the standard approach, while ensuring similar clinical and safety outcomes.

To compare vHPSD AF ablation with a matched control cohort undergoing standard power and duration (SPD) AF ablation at our centre, regarding clinical outcomes, procedural efficiency and safety.

We include all patients who underwent first AF catheter ablation between January 2021 and May 2024. SDP AF ablation (35W RF applications guided by Ablation Index) was performed until April 2022, after which vHPSD AF ablation (90W/4s) became the standard approach. The two groups were matched using a propensity score analysis and then compared regarding freedom from AF recurrence, contacts with healthcare (composite of emergency department (ED) visits due to AF or congestive heart failure (CHF); hospitalizations due to CHF, AF, acute coronary syndrome or stroke; electric cardioversion; or redo procedure), procedural efficiency, and safety.

308 patients were submitted to pulmonary vein (PV) isolation, and after the propensity score analysis, 210 patients were analysed (64,8% male, median age 62 years (IQR 54,7–67,5)). There were 105 patients in each group with comparable baseline characteristics. The median follow-up time was 364 days (IQR 207–548) for the vHPSD group and 729 days (IQR 559–730) for the STD group. Freedom from AF recurrence at 12 months was similar between groups in the survival analysis (86,6% vs 88,4%, p=0,510) (Figure 1). Healthcare contacts were numerically higher in the SPD group, but this difference was not statistically significant (10,5% vs 19,1%, p=0,08). However, ED visits due to AF or CHF were more frequent in the SPD group during follow-up (4,8% vs 14,9%, p=0,02). Total procedural time, ablation time, and RF application time were significantly shorter in the vHSPD arm (86,5min vs 100,0min, p<0,001; 32,0min vs 45min, p<0,001, and 7min vs 24,5min, p<0,001, respectively). PV first-pass isolation (FPI) was obtained in 54,5% of patients in the vHPSD group and 72,0% in the SPD group (p=0,004). Overall, AF catheter ablation had a favourable safety profile, with a low prevalence of adverse effects, irrespective of the type of RF energy used (one pericardial effusion in the vHPSD group and one pericarditis in the SDP group).

VHPSD AF ablation was a more efficient technique with a shorter procedural time, achieving similar clinical outcomes despite having a lower FPI rate. Both procedures were safe with low prevalence of adverse effects.

Freedom from AF recurrence.