LSI guided-high power short duration is safe and improves pulmonary vein isolation efficiency

Abstract

Abstract Introduction High-power short-duration (HPSD) is an increasingly used ablation strategy for pulmonary vein isolation (PVI) procedures, but Lesion Index (LSI)-guided HPSD radio-frequency (RF) application has not been described in this clinical setting. Purpose We evaluated the procedural efficiency and safety of an LSI-guided HPSD strategy for atrial fibrillation (AF) ablation. Methods Paroxysmal and persistent AF patients scheduled for AF ablation were prospectively enrolled and divided in two groups, according to the ablation power used. The LSI-HP Group included patients ablated with a RF power of 50 Watts and the LSI-LP Group included patients ablated with 35 Watts. All patients underwent only PVI under LSI guidance (LSI between 5.5 and 6 anteriorly; LSI between 4.5 and 5 posteriorly) with a point by point strategy and an inter-lesion distance <6 mm. Procedural efficiency parameters were compared between groups. Results Forty-six patients with AF (60% paroxysmal) were prospectively enrolled, 25 in the LSI-HP Group and 21 in the LSI-LP Group. They were usually male (78%) with a low-intermediate CHA2DS2-Vasc score (1.8±1.1), a preserved ejection fraction (60±6%) and moderate left atrial dilatation (45±6 mm). Baseline clinical characteristics resulted comparable between groups (p=NS). PVI was successful in all patients. RF time (30.22±9.04 vs 47.85±11.87 min, p<0.0001), total procedure time (138.7±33.2 vs 177.6±49.77, p=0.006) and fluoroscopy time (13.92±5.34 vs 23.14±10.97 min, p=0.006) were significantly lower in the LSI-HP Group. No complication or steam pops was seen in either group. Conclusions LSI-HP AF ablation significantly improves procedural efficiency, reducing ablation time, total procedural duration and fluoroscopy use, while maintaining a comparable safety profile as lower powers. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2