PO-01-094 LESION SIZE INDEX-GUIDED HIGH POWER ABLATION FOR PULMONARY VEIN ISOLATION IN PATIENTS WITH PAROXYSMAL ATRIAL FIBRILLATION: PROCEDURAL DATA AND LONG TERM OUTCOME

Abstract

Lesion size index (LSI) is useful to complete pulmonary vein isolation (PVI) for atrial fibrillation (AF). High-power application with LSI guided ablation strategy (HP-LSI) may shorten the time to complete PVI. However, the long-term outcome for HP-LSI was limited. To assess the rhythm outcome between HPSD and HP-LSI ablation strategies. 147 paroxysmal AF patients who underwent PVI by TactiCath ablation catheter were enrolled retrospectively. The first 80 patients were assigned to high power short duration ablation strategy (HPSD, anterior wall 50W, posterior wall 40 W, 10 seconds for each lesion), and the subsequent 67 patients were applied with HP-LSI strategy (anterior wall 50W/LSI at least 5.0, posterior wall 40W/LSI 4.0 to 4.5, with 20 seconds limited for each lesion). The primary outcome was AF recurrence between groups. PVI time and first-pass isolation rate were considered as the secondary outcome. Over 12 months of follow-up, there was a significantly lower rate of AF recurrence in the HP-LSI group compared to the HPSD group (14.9% vs. 32.5%, p = 0.020). The PVI time was shorter (63.7 minutes vs. 87.7 minutes, p < 0.001), and the first pass isolation rate were higher for both PVs (RPV: 42.2% vs. 13.7%, p = 0.003; LPV: 66.7% vs. 31.4%, p = 0.001) in HP-LSI group than HPSD group. Besides, there were fewer gaps found in several PV segments in the HP-LSI group after the first pass PV circumferential ablation. HP-LSI can shorten PVI time with a higher first-pass isolation rate in both PVs compared to HPSD. HP-LSI guided strategy decreases gap rates both in RPV and LPV. Compared to HPSD, the HP-LSI ablation strategy can result in a durable PVI outcome.