Abstract
IntroductionHigh-power short-duration (HPSD) ablation is a novel strategy using contact force-sensing catheters optimized for radiofrequency ablation for atrial fibrillation (AF). No study has directly compared HPSD versus standard-power standard-duration (SPSD) contact force-sensing settings in patients presenting for repeat ablation with AF recurrence after initial ablation.MethodsWe studied consecutive cases of patients with AF undergoing repeat ablation with SPSD or HPSD settings after their initial pulmonary vein isolation (PVI) with temperature controlled non-contact force, SPSD or HPSD settings between 6/23/14 and 3/4/20. Procedural data collected included radiofrequency ablation delivery time (RADT). Clinical data collected include sinus rhythm maintenance post-procedure.ResultsA total of 61 patients underwent repeat ablation (36 SPSD, 25 HPSD). A total of 51 patients (83.6%) were found to have pulmonary vein reconnections necessitating repeat isolation, 10 patients (16.4%) had durable PVI and ablation targeted non-PV sources. RADT was shorter when comparing repeat ablation using HPSD compared to SPSD (22 vs 35 min; p = 0.01). There was no difference in sinus rhythm maintenance by Kaplan–Meier survival analysis (log rank test p = 0.87), after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume index, CHA2DS2-VASc score, or left ventricular ejection fraction.ConclusionWe demonstrated that repeat AF ablation with HPSD reduced procedure times with similar sinus rhythm maintenance compared to SPSD in those presenting for repeat ablation.
Highlights
High-power short-duration (HPSD) ablation is a novel strategy using contact force-sensing catheters optimized for radiofrequency ablation for atrial fibrillation (AF)
There was no difference in age, sex, type of AF, C HA2DS2-VASc score, anti-arrhythmic drug use at different follow-up time periods, left atrial volume index (LAVI), or left ventricular ejection fraction (LVEF) between groups
Our study demonstrates that HPSD reduced procedural times compared to standard-power standard-duration (SPSD) ablation with no difference in sinus rhythm maintenance in patients presenting for repeat RF ablation for AF
Summary
High-power short-duration (HPSD) ablation is a novel strategy using contact force-sensing catheters optimized for radiofrequency ablation for atrial fibrillation (AF). No study has directly compared HPSD versus standard-power standard-duration (SPSD) contact force-sensing settings in patients presenting for repeat ablation with AF recurrence after initial ablation. Conclusion We demonstrated that repeat AF ablation with HPSD reduced procedure times with similar sinus rhythm maintenance compared to SPSD in those presenting for repeat ablation. The foundation of radiofrequency (RF) catheter ablation for atrial fibrillation lies in the electrical isolation of the pulmonary veins (PVI) from the left atrium [1, 2]. This technique is proven to be effective and safe in reducing AF burden [1, 2]. The mechanism behind PV reconnection is incompletely understood, though incomplete ablation with partial thickness lesions or reversible injury is thought to be an important contributor [3,4,5]
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