PO-01-041 COMPARISON OF DIFFERENT POWER SETTINGS (40W VS 50W) IN HIGH-POWER SHORT-DURATION RADIOFREQUENCY ABLATION FOR PAROXYSMAL ATRIAL FIBRILLATION: ACUTE AND LONG-TERM CLINICAL OUTCOMES

Abstract

The REAL-AF registry is a prospective multi-center registry designed to obtain real-world clinical experience of atrial fibrillation (AF) ablations. While pulmonary vein isolation (PVI) can be performed successfully with various power settings, there has been a recent surge of interest in delivering higher power short duration (HPSD) lesions using 40W-50W through the irrigated tip ablation catheters. However, the ideal power setting to deliver HPSD lesions is unknown. Compare the procedural characteristics, safety and long-term all-atrial arrhythmia recurrence between patients undergoing HPSD radiofrequency ablation either using 40W or 50W. We analyzed the data derived from subjects in the Real-AF registry from January 2018 through May 2021. The patients enrolled underwent a first-time catheter ablation for paroxysmal AF with a minimum follow-up of 12 months. The sample of patients was dichotomized in procedures using either HPSD 50 W or HPSD 40 W of power, with a target ablation index (AI) in the anterior wall of 500-550 and posterior wall of 400 for both groups. We used unadjusted bivariate analyses to explore the relationship between power delivery, patient characteristics and procedural and 12-month clinical outcomes. A total of 385 patients were included in the analyses. There were no significant differences in patient characteristics between groups (Table 1). The HPSD 50W group had significantly shorter RF time (18.69 vs. 29.21, p<0.001) and procedural time (77.72 vs. 99.98, p<0.01) when compared to the LPLD group. There were no statistically significant differences between HPSD 50 W and HPSD 40W for first-pass PVI and no clinically significant differences in the target ablation index between the groups. When looking at all -atrial arrhythmia recurrence documented post-blanking period at 12 months, there was no statistically significant relationship (p=0.925) between groups. There was no statistically significant relationship between immediate procedural complications, pericarditis, or complications at 12 months post-ablation (p>0.05). The esophageal temperature measurements were not different between groups. HPSD is a safe and effective way of performing radiofrequency ablation of AF. HPSD using 50W was associated with shorter RF ablation and procedural times when compared to HPSD 40W without increase in complications HPSD 50W and HPSD 40W had similar acute and long-term success rates.