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

D-PO02-196 - Improved Procedural Efficiency With Stability-optimized High-power Short-duration Left Atrial Posterior Wall Isolation For Non-paroxysmal Atrial Fibrillation (ID 251)

Abstract

Background: Studies comparing outcomes of high-power, short-duration (HPSD) radiofrequency ablation (RFA) to those of conventional-power, conventional-duration (CPCD) RFA have yielded mixed results. High-frequency JET ventilation (HFJV) and rapid pacing have recently been shown to improve catheter stability. Procedural outcomes of HPSD RFA in combination with HFJV and rapid pacing have not been reported.
Objective: To compare outcomes of patients undergoing RFA pulmonary vein isolation and left atrial posterior wall isolation for non-paroxysmal atrial fibrillation (NPAF) utilizing HPSD and optimized catheter stability with HFJV and rapid pacing to those of CPCD standard mechanical ventilation and intrinsic rhythm.
Methods: Procedural outcomes of patients with NPAF undergoing first-time RFA at NYU Langone Medical center were analyzed. Group 1 consisted of 111 consecutive patients who underwent RFA between October 2015 and August 2016 with a contact-force sensing (CFS) RFA catheter with power set to 30-35W, conventional mechanical ventilation, and native rhythm. Group 2 consisted of 111 consecutive patients who underwent RFA between March 2018 and August 2018 using HPSD, HFJV, and rapid pacing. Arrhythmia recurrence was assessed using 2-week event monitors at 3-month intervals following index ablation as well as any repeat ablation.
Results: Baseline characteristics of the two groups were similar. Relative to Group 1, Group 2 had a shorter procedure duration (190 vs 162 min, p<0.001), shorter fluoroscopy time (17 vs 12 min, p=0.014), and shorter radiofrequency ablation time (81 vs 55 min, p<0.001) with a similar incidence of major complications (0.9 vs 0%, p=0.318). The rate of arrhythmia recurrence (atrial fibrillation or atrial tachycardia) at 12 months was similar between the two groups (22% vs 18%, p=0.471), although there was a trend towards less recurrence of atrial tachycardia in the HPSD group (14% vs 6%, p=0.08).
Conclusion: Compared to conventional techniques, stability-optimized HPSD RFA of NPAF is similarly safe and effective with shorter procedure duration, less radiation exposure, and less radiofrequency ablation time.
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