Comparison of clinical and procedural outcomes between high‐power short‐duration, standard‐power standard‐duration, and temperature‐controlled noncontact force guided ablation for atrial fibrillation

Introduction: High-power short-duration (HPSD) ablation via the St. Jude EnSite™ Velocity™ system (St. Paul, MN) utilizes 50W delivered for up to 15s, guided by a Lesion Size Index of 5-6 specific to the Velocity™ system. HPSD is a novel way to use a contact force-sensing catheter optimized for power-controlled radiofrequency ablation of atrial fibrillation (AF). Procedural and clinical outcomes of HPSD compared to standard-power standard-duration (SPSD; 20-25W until 400-500 gram seconds, up to 60s) and temperature-controlled non-contact (TCNC; 20-40W up to 60s of ablation) settings would inform this strategy. Methods: We studied consecutive cases of patients with paroxysmal or persistent AF undergoing pulmonary vein isolation (PVI) with TCNC, SPSD, and HPSD between 7/1/13 to 11/1/19. Procedural data collected include total radiofrequency time (RFT), time to isolate the left pulmonary veins (LPVT), time to isolate the right pulmonary veins (RPVT), and safety outcomes. Clinical data collected include sinus rhythm maintenance 3 and 12-months post-procedure. Results: A total of 171 patients were studied (44 TCNC, 51 SPSD, 76 HPSD). There was no difference in age, sex, or AF type between groups. RFT was shorter when comparing HPSD to SPSD (71 vs 101 min; p<0.01), HPSD to TCNC (71 vs 146 min; p<0.01), and SPSD to TCNC groups (101 vs 146 min; p<0.01). This was driven by decreases in LPVT between the HPSD vs SPSD (34 vs 46 min; p=0.04), HPSD vs TCNC (34 vs 72 min; p<0.01), and SPSD vs TCNC groups (46 vs 72 min; p<0.01), as well as decreases in RPVT between the HPSD vs SPSD (42 vs 54 min; p=0.03), HPSD vs TCNC (42 vs 75 min; p<0.01), and SPSD vs TCNC groups (54 vs 75 min; p<0.01). There was no difference in sinus rhythm maintenance after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume, CHA 2 DS 2 -VASc score, or left ventricular EF. There was a numerical difference in safety with no adverse events in HPSD (0/76 in HPSD vs 1/51 in SPSD vs 3/44 in TCNC; p=0.06). Conclusion: AF ablation with contact force utilizing an HPSD ablation strategy reduced procedure times with similar sinus rhythm maintenance compared to SPSD and TCNC approaches. Further research is needed to determine whether clinical outcomes differ with a larger population and longer follow-up.

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High-power short-duration versus standard-power standard-duration settings for repeat atrial fibrillation ablation

Heart and Vessels ◽

10.1007/s00380-021-01987-9 ◽

2021 ◽

Author(s):

Joey Junarta ◽

Sean J. Dikdan ◽

Naman Upadhyay ◽

Sairamya Bodempudi ◽

Michael Y. Shvili ◽

...

Keyword(s):

Atrial Fibrillation ◽

Radiofrequency Ablation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Contact Force ◽

High Power ◽

Force Sensing ◽

Standard Duration ◽

Sinus Rhythm Maintenance ◽

Power Standard

Abstract Introduction High-power short-duration (HPSD) ablation is a novel strategy using contact force-sensing catheters optimized for radiofrequency ablation for atrial fibrillation (AF). No study has directly compared HPSD versus standard-power standard-duration (SPSD) contact force-sensing settings in patients presenting for repeat ablation with AF recurrence after initial ablation. Methods We studied consecutive cases of patients with AF undergoing repeat ablation with SPSD or HPSD settings after their initial pulmonary vein isolation (PVI) with temperature controlled non-contact force, SPSD or HPSD settings between 6/23/14 and 3/4/20. Procedural data collected included radiofrequency ablation delivery time (RADT). Clinical data collected include sinus rhythm maintenance post-procedure. Results A total of 61 patients underwent repeat ablation (36 SPSD, 25 HPSD). A total of 51 patients (83.6%) were found to have pulmonary vein reconnections necessitating repeat isolation, 10 patients (16.4%) had durable PVI and ablation targeted non-PV sources. RADT was shorter when comparing repeat ablation using HPSD compared to SPSD (22 vs 35 min; p = 0.01). There was no difference in sinus rhythm maintenance by Kaplan–Meier survival analysis (log rank test p = 0.87), after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume index, CHA2DS2-VASc score, or left ventricular ejection fraction. Conclusion We demonstrated that repeat AF ablation with HPSD reduced procedure times with similar sinus rhythm maintenance compared to SPSD in those presenting for repeat ablation.

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Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2021.100847 ◽

2021 ◽

Vol 35 ◽

pp. 100847

Author(s):

Roland Richard Tilz ◽

Makoto Sano ◽

Julia Vogler ◽

Thomas Fink ◽

Roza Saraei ◽

...

Keyword(s):

Pulmonary Vein ◽

Short Duration ◽

Pulmonary Vein Isolation ◽

High Power ◽

Temperature Controlled ◽

Very High

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High-power, short-duration ablation versus conventional technique in Box isolation for atrial fibrillation

10.22541/au.159050294.45428468 ◽

2020 ◽

Author(s):

Koichiro Kumagai ◽

Hideko Toyama

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

High Power ◽

Conventional Technique

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Pulmonary Vein Isolation With Very High Power, Short Duration, Temperature-Controlled Lesions

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2019.04.009 ◽

2019 ◽

Vol 5 (7) ◽

pp. 778-786 ◽

Cited By ~ 39

Author(s):

Vivek Y. Reddy ◽

Massimo Grimaldi ◽

Tom De Potter ◽

Johan M. Vijgen ◽

Alan Bulava ◽

...

Keyword(s):

Pulmonary Vein ◽

Short Duration ◽

Pulmonary Vein Isolation ◽

High Power ◽

Temperature Controlled ◽

Very High

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High‐power, short‐duration ablation during Box isolation for atrial fibrillation

Journal of Arrhythmia ◽

10.1002/joa3.12407 ◽

2020 ◽

Vol 36 (5) ◽

pp. 899-904

Author(s):

Koichiro Kumagai ◽

Hideko Toyama

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

High Power

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High-Power, Short-Duration Ablation in the Treatment of Atrial Fibrillation Patients

10.5772/intechopen.100218 ◽

2021 ◽

Author(s):

Nándor Szegedi ◽

László Gellér

Keyword(s):

Atrial Fibrillation ◽

Short Duration ◽

High Power ◽

Pulmonary Veins ◽

Long Term Results ◽

Control Treatment ◽

Technical Developments ◽

Radiofrequency Lesions ◽

Two Phases

Catheter ablation is the cornerstone of the rhythm control treatment of atrial fibrillation (AF). During this procedure, creating a contiguous and durable lesion set is essential to achieve good long-term results. Radiofrequency lesions are created in two phases: resistive and conductive heating. The ablation catheters and the generators have undergone impressive technical developments to enable homogenous and good-quality lesion creation. Despite recent years’ achievements, the durable isolation of the pulmonary veins remains a challenge. These days, intensive research aims to evaluate the role of high-power radiofrequency applications in the treatment of patients with cardiac arrhythmias. The use of high-power, short-duration applications might result in a uniform, transmural lesion set. It is associated with shorter procedure time, shorter left atrial, and fluoroscopy time than low-power ablation. This technique was also associated with a better clinical outcome, possibly due to the better durability of lesions. Multiple clinical studies have proven the safety and efficacy of high-power, short-duration PVI.

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Efficacy and safety of 50-60 Watt high-power short-duration radiofrequency catheter ablation of atrial fibrillation: A propensity score matching study

EP Europace ◽

10.1093/europace/euab116.210 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

HN Pak ◽

SY Yang ◽

M Kim ◽

HT Yu ◽

TH Kim ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Propensity Score ◽

Propensity Score Matching ◽

Short Duration ◽

High Power ◽

Volume Index ◽

Ablation Lesion ◽

Efficacy And Safety ◽

Clinical Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although high-power short-duration (HPSD) radiofrequency (RF) energy is commonly utilized in atrial fibrillation (AF) catheter ablation (CA), its efficacy, safety, and autonomic neural effects have not yet been evaluated in a large patient number. We compared HPSD-AFCA and conventional power (ConvP)-AFCA after propensity score matching. Methods Among 3,221 consecutive AF ablation patients, we included 1,720 patients (74.4% male, 59 ± 10 years old, 56.5% paroxysmal type) who underwent AFCA after propensity score matching: 430 in 50∼60W HPSD group vs. 1,290 in the ConvP group. We evaluated the procedural factors, complication risk, rhythm outcome, and 3-month heart rate variability (HRV) between the two groups and subgroups. Results Procedure times were significantly shorter in the HPSD group (p < 0.001), but the complication rate (p = 0.088) and the 3rd-month HRV did not differ between the two groups. At the 12-month follow-up, rhythm outcomes did not differ between the two groups (Overall, Log-rank p = 0.212; anti-arrhythmic drug off Log rank p = 0.246). These efficacy and safety outcomes were consistently similar regardless of the AF type or ablation lesion set. In the Cox regression analysis, the left atrium volume index measured by computed tomography (HR 1.009 [1.003-1.015]), p = 0.005) and extra-pulmonary vein triggers (HR 1.587 [1.033-2.440], p = 0.035) were independently associated with 1-year clinical recurrence, while the HPSD strategy was not (HR 1.188 [0.903-1.564], p = 0.218). Conclusions HPSD-AFCA significantly shortened the procedure time with similar rhythm outcomes, complication risks, and autonomic neural effects as ConvP-AFCA, regardless of the AF type or ablation lesion set. Abstract Figure.

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