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

D-PO02-149 - High Energy-Short Duration Radiofrequency Ablation For Left Atrial Posterior Wall Isolation During Ablation Of Atrial Fibrillation (ID 227)

Abstract

Background: Left atrial posterior wall isolation may be incrementally beneficial beyond PVI alone to reduce arrhythmia recurrence for ablation of persistent AF. However, concerns about safety of high power ablation on the posterior wall, and increased procedure time and complexity, has limited the application of this approach. High power short duration (HPSD) ablation may allow an efficient, effective, and safe method for posterior wall ablation.
Objective: Compare the safety, procedure time, and effectiveness of HSPD ablation vs. conventional power ablation to achieve concomitant PVI and left atrial posterior wall isolation during ablation of AF.
Methods: 94 consecutive AF ablations during which left atrial posterior wall isolation was performed were included in this retrospective analysis. Only patients with at least 6 months of follow-up were included. All procedures were performed in a single facility under general anesthesia, using eletroanatomic mapping, esophageal temperature monitoring, and point-by-point lesion application using a contact force-sensing ablation catheter delivered through a deflectable sheath. High power short duration ablation was defined as 40-50W for 5-10 seconds/lesion, and conventional power was 20-35W at up to 30 seconds/lesion.
Results: PVI was performed successfully in all patients. The left atrial posterior wall was successfully isolated in 24/26 (92%) patients undergoing conventional ablation, and 65/68 (96%) patients undergoing HPSD ablation (p=0.61). Procedure duration was shorter in the HPSD group (254± 57 vs. 321± 59 mins, p<0.01). AF recurrence (>30 days post-ablation) occurred in 25% of the conventional ablation group, and 13.5% of the HPSD group (p=0.20). No identified esophageal injury, pericardial effusions, or strokes occurred in either group; one vascular adverse event occurred in the HPSD group.
Conclusion: HPSD ablation was performed with a high degree of safety, efficiency and acute efficacy in patients undergoing posterior wall isolation during ablation of AF. Procedure times were shorter, and 6 month success rates were high, with HPSD ablation. Further long-term data is needed to determine the incremental benefits of this strategy compared to conventional ablation.
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