Comparison of high-power and conventional-power radiofrequency energy deliveries in pulmonary vein isolation using unipolar signal modification as a local endpoint.

Koichiro Ejima,Satoshi Higuchi,Daigo Yagishita,Kyoichiro Yazaki,Shohei Kataoka,Nobuhisa Hagiwara,Miwa Kanai,Morio Shoda

doi:10.1111/jce.14532

Abstract

IntroductionNegative component abolition of the unipolar signal (unipolar signal modification [USM]) reflects the lesion transmurality. The purpose of this study was to compare the procedural safety and outcome between high‐power and conventional‐power atrial radiofrequency applications during a pulmonary vein isolation (PVI) using USM as a local endpoint.Methods and ResultsHigh‐power (50 W) and conventional‐power (25‐40 W) applications were compared among 120 consecutive patients with paroxysmal atrial fibrillation who underwent a USM‐guided PVI. The first 60 patients were treated with conventional‐power (CP) group and last 60 with high‐power (HP) group. The atrial radiofrequency applications lasted for 5 to 10 seconds (CP group) or 3 to 5 seconds (HP group) after the USM. All procedures were performed using 3D mapping systems with image integration and esophageal temperature monitoring. The baseline characteristics were similar between the two groups. The HP group had fewer acute PV reconnections (62% vs 78%; P = .046) and a reduced procedure time (119.3 ± 28.1 vs 140.1 ± 51.2 minutes; P = .04). Freedom from recurrence after a single ablation procedure without any antiarrhythmic drugs was higher in the HP group than CP group (88.3% vs 73.3% at 12‐months after the procedure, log‐rank; P = .0423). There were no major complications that required any intervention.ConclusionsThe high‐power PVI guided by USM decreased the procedural time and may improve the procedural outcomes without compromising the safety.

Highlights

Negative component abolition of the unipolar signal reflects the lesion transmurality
We hypothesized that the high‐power RF application under guidance of unipolar signal modification (USM) may enhance the durability of the isolated PV and procedural outcome of the atrial fibrillation (AF) ablation in patients with paroxysmal AF (PAF)
A pulmonary vein isolation (PVI) was defined as bidirectional block between the LA and inside the circumferential PVI (CPVI) area and was confirmed by the electrograms recorded from circular mapping catheters and pacing maneuvers followed by at least a 20‐minute waiting period

Summary

| INTRODUCTION

Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation.[1]. To reduce the recurrence rate after AF ablation procedures, the establishment of a dependable ablation strategy that enhances the quality of the radiofrequency (RF) applications during the PVI and achieves a so called durable PVI is desirable. It has been demonstrated in a porcine model that complete elimination of the negative component of the unipolar atrial electrogram (R morphology achievement), while applying RF energy, is always associated with transmural lesions.[4]. We hypothesized that the high‐power RF application under guidance of USM may enhance the durability of the isolated PV and procedural outcome of the AF ablation in patients with paroxysmal AF (PAF). The aim of this study was to compare the procedural safety and outcomes of high‐power and conventional RF power energy deliveries during the PVI using USM as a local endpoint

| METHODS

| RESULTS

Procedures other than a PVI

Findings

| DISCUSSION