Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-202 - Safety And Efficacy High Power Short Duration Technique For Pvi Ablation Using Ablation Index Guidance. A Preliminary Single-center Experience (ID 1057)

 A. Berkovitz: Nothing relevant to disclose.


Background: Catheter contact, ablation energy and duration are important parameters for success in atrial fibrillation procedures. These parameters also predict the risk of collateral damage. Ablation Index (AI), calculated by integration of multiple catheter informations during ablation at a single site has been associated with superior efficacy. High power ablation for short duration may be directed by AI but effect on acute efficacy and safety has not been evaluated.
Objective: Evaluate efficacy and safety of the high power short duration technique for PVI using ablation index guidance. Esophageal thermal lesions as well as first path isolation, ablation times and acute reconnexion sites were evaluated.
Methods: Ablation of AF de novo was performed encircling ipsilateral pulmonary veins with wide circumferential ablation lines and in Redo procedures reconnected PVs were re-isolated as well as substrate modification when present. 50 Watts were delivered for all ablation targets with the help of specific pre-determined AI values (350 for posterior, 450 for anterior and roof walls). First path isolation for de novo PVIs, location of re-ablation after reconnection during the waiting period after PVI (30min), ablation according to the walls and procedure times as well as endoscopically detected thermal esophageal lesions, performed 1 to 3 days after procedure, were evaluated for every patient
Results: 193 consecutive patients were included. 18% were Redo procedures. Acute isolation was achieved in all cases. Mean ablation time was 15 minutes for first PVI. 9 patients (5%) had documented superficial esophageal lesions. Bilateral first path isolation could be attained in 67,6% (86% for left sided and 68% for right-sided PVs). Acute reconnections were most commonly detected on the RIPV posteriorly in 13% of the de novo ablations. No relevant complications were noted in this cohort of patients.
Conclusion: High power short duration ablation aiming for prespecified AI may allow efficient and safe lesions for PVI. Collateral thermal damage of the esophagus was documented in 5% of patients, not clinically relevant complications were noted. Short procedure duration due to shorter ablation times is an additional benefit of high power ablations using short delivery times.