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

D-PO02-141 - Feasibility And Safety Of Box Isolation With High-power And Short-duration Ablation (ID 223)

 H. Toyama: Nothing relevant to disclose.


Background: Recently, it has been reported that high-power and short-duration (HPSD) ablation during pulmonary vein isolation is feasible. However, the optimal radiofrequency power and duration setting on the left atrial (LA) posterior wall near the esophagus is still unclear.
Objective: This study evaluated the feasibility and safety of HPSD ablation during the LA posterior wall box isolation (BOXI).
Methods: A total of 160 patients with atrial fibrillation (AF) undergoing BOXI with HPSD ablation (50 W, n = 80, average age; 63.0 ± 9.1 years, paroxysmal AF; 30) or low-power and long-duration (LPLD) ablation (<35 W, n = 80, average age; 62.8 ± 9.0 years, paroxysmal AF; 25) were analyzed. In HPSD group, all ablations except near the esophagus were at 50 W with the target lesion size index of 5.0 or for ≤20 seconds using a contact force sensing catheter (TactiCath, Abbott). Ablations near the esophagus were at 50 W for 5 seconds and CF <10 g. In LPLD group, all ablations except near the esophagus were at ≤35 W for 30 seconds using a non-contact force sensing catheter (FlexAbility, Abbott). Ablations near the esophagus were at 20-30 W for 10 to 30 seconds, but ablation was stopped with increasing esophageal temperature of 40°C.
Results: There was no gastrointestinal symptoms, gastric hypomotility and atrioesophageal fistulas in the 2 groups. Total radiofrequency energy in HPSD group was significantly lower than that in LPLD group (42988 ± 18219 vs 78030 ± 22411 J, p<0.0001). The mean radiofrequency duration of each lesion (12.6 ± 3.2 vs 26.5 ± 1.6 seconds, p<0.0001), BOXI creation time (26 ± 8 vs 47 ± 17 minutes, p<0.0001), procedure time (65 ± 12 vs 87 ± 23 minutes, p<0.0001), fluoroscopic time (18 ± 5 vs 22 ± 6 minutes, p<0.0001) in HPSD group were significantly shorter than those in LPLD group. The number of pacing capture sites was not different between 2 groups (10.6 ± 5.5 vs 9.4 ± 6.2, P=0.223). No complications occurred. AF recurrence rates were similar in the 2 groups for the mean 8.5 ± 2.7 months follow-up period (15.0% in HPSD vs 22.5% in LPLD; p = 0.224).
Conclusion: HPSD ablation of the LA posterior wall does not increase the esophageal thermal injury. BOXI with HPSD ablation is feasible and safe with short procedure time and small amounts of total radiofrequency energy delivery.