Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-AB09 - Advances in Radiofrequency Ablation Lesion Science: Optimizing Settings and Outcomes (ID 46) Abstract

D-AB09-03 - High Power, Short Duration Atrial Fibrillation Ablation; One-year Outcomes Compared To A Conventional ‘Lower Power’ Approach (ID 754)


Background: Published data comparing high-power short-duration (HPSD) ablation to conventional power strategies during atrial fibrillation (AF) ablation are lacking.
Objective: Compare freedom from AF at 12 months following HPSD ablation verses a conventional power strategy.
Methods: We evaluated consecutive patients undergoing a first ablation procedure for paroxysmal or persistent AF using HPSD ablation. HPSD settings were 50 watts, duration 6-8 seconds posteriorly and 8-10 seconds anteriorly. Cases were compared to matched controls who underwent a conventional lower power ablation with 20-30 watts posteriorly (duration 20-30 seconds) and 30-35 watts anteriorly (duration 30-45 seconds). All physicians used the same ablation settings in both groups with a maximum inter-lesion distance of 4mm. All patients underwent pulmonary vein isolation (PVI) with the endpoint of entry and exit block. Patients undergoing ablation for persistent AF received additional ablation to low voltage areas when present, at the discretion of the operator. All patients were followed up with 2-week Holter’s and clinical assessment at 3, 6 and 12 months. The primary endpoint was defined as freedom from AF (<30 seconds duration as defined by the HRS consensus statement).
Results: 214 patients were prospectively included (107 HPSD ablations, 107 standard ablation controls). The groups were well matched on all baseline characteristics; age (mean 62+9 years in both groups), CHA2DS2-VASc score, hypertension, diabetes, ischemic heart disease and type of atrial fibrillation. In the HPSD group 67 (63%) patients had paroxysmal AF, compared to 66 (62%) in the standard group. In the HPSD and standard groups freedom from AF was seen in 79 (74%) and 80 (75%) patients respectively (p=0.875). When assessed by type of AF, 51/67 patients with paroxysmal AF in the HPSD group were free of AF (76%) versus 53/66 patients (80%) in the standard group (p=0.559). In the persistent AF group 28/40 (70%) patients in the HPSD and 27/41 (67%) in the standard group were AF free (p=0.689). Procedure duration was significantly shorter in the HPSD group (229+60 vs 324+120 minutes) (p<0.0005).
Conclusion: HPSD AF ablation resulted in similar freedom from AF at 12-months when compared to conventional ablation settings.