Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Clinical Trials / Outcomes D-PO01 - Featured Poster Session (ID 11) Poster

D-PO01-171 - Effect Of Higher Power For Shorter Duration Ablation Strategy In Patients With Atrial Fibrillation (ID 125)

Disclosure
 D. Shin: Nothing relevant to disclose.

Abstract

Background: Radiofrequency (RF) lesion formation depends on RF power and ablation duration as well as contact force (CF). Although increased RF power can create more continuous and transmural lesion, most of centers still use power of 25-30 W for durations of 30-40 seconds at each ablation point because of safety concern about using higher power (HP)
Objective: We evaluated the clinical efficacy and safety of HP application with short duration (HPSD) for atrial fibrillation (AF) ablation
Methods: One hundred fifty patients (58.2±10.0 years, 48% in paroxysmal AF [PAF]) scheduled for index AF ablation using a CF-sensing catheter were randomly assigned to 3 groups (30W/40sec, 40W/20sec, and 50W/10sec at ablation sites of left atrial [LA] anterior wall and roof line). 25-30 W for ≤20sec was applied at posterior wall ablation site in all subjects
Results: Compared with 30W/40sec and 40W/20sec groups, 50W/10sec group had shorter procedure time (p<0.001), ablation time (p<0.001), and fluoroscopy time (p=0.001). There were no significant differences in CF and ablation index (AI) among 3 groups. In each group, AI increased proportionally as CF increased. There were no significant differences in procedure-related complications. During a 12-month follow-up period, AF recurrence occurred in 24 (16%) patients and revealed no significant difference among 3 groups (p=0.769). In multivariate analysis, non-PAF (HR 2.912, 95% CI 1.045-8.119, p=0.041) and CF (HR 0.736, 95% CI 0.628-0.863, p<0.001) were independent risk factors for AF recurrence
Conclusion: RF ablation with HPSD limited to LA anterior wall and roof line is a safe and effective strategy with reduced procedure, ablation, and fluoroscopy times
Procedural data

Overall (n=150)30W/40sec (n=50)40W/20sec (n=50)50W/10sec (n=50)P-value
Procedure time, min135.4±37.5161.9±37.9135.6±29.5108.7±23.1<0.001
Ablation time, min75.2±26.893.1±30.572.3±21.560.2±14.7<0.001
Fluoroscopy time, min11.1±3.812.5±3.611.0±3.09.7±4.10.001
Contact force, g12.1.1±3.412.1±4.012.2±2.912.1±3.30.979
Ablation duration/point, sec17.7±7.225.7±4.715.9±3.511.6±3.9<0.001
Force time integral, gs222.3±120.6318.2±129.0200.5±74.5148.1±81.0<0.001
Force time power integral, gsw8252.9±3751.69495.9±3869.47949.9±2979.37312.9±4047.80.011
Ablation index445.5±46.5452.8±49.6447.7±44.5435.9±46.50.184
Additional LA ablation31 (20.7)12 (24.0)11 (22.0)8 (16.0)0.589
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