Safety and effectiveness evaluation of high power short-term radiofrequency ablation for atrial fibrillation

Abstract

Objective To observe the immediate efficacy, operational efficiency and perioperative safety of high power (50-60 W) radiofrequency ablation for atrial fibrillation (AF) . Methods A total of 72 patients with AF were analyzed retrospectively, who were admitted to Tianjin Medical University General Hospital from April to September 2019, and received 50-60 W high-power bilateral pulmonary venous isolation (PVI) by the same practitioner. All patients with paroxysmal or persistent AF underwent catheter ablation for the first time. Perioperative management was performed according to the routine of our center. And catheter ablation was performed according to the type of AF and the intraoperative seizure. High power ablation was guided by ablation index (AI) or predicted AI (reference values: 450 for anterior wall, and 350 for posterior wall) . The patients’ baseline data, immediate success rate, single-turn isolation rate of PVI, ablation time, and operating time, as well as perioperative complications were analyzed. Results A total of 72 patients were analyzed, with average age of (66.00±9.98) years, males accounted for 54.17%, left atrial anteroposterior diameter of (41.54±5.24) mm, paroxysmal AF accounted for 63.99%, CHA2DS2-VASc scores of (2.81±1.62) . Fifty-five patients received ablation using 60 W, while 17 patients were ablated using 50 W, and all patients were recovered to sinus rhythm at the end of operation. For all patients, the single-turn isolation rate of bilateral PVI was 87.5% (93.48% for paroxysmal AF) , while the ablation time was (924.90±316.24) s, and the double-loop operation time was (28.89±10.16) minutes. In 60 W group, the single-turn isolation rate of bilateral PVI was 89.09% (94.59% for paroxysmal AF) , while the ablation time was (855.93±306.78) s, and the double-loop operation time was (26.62±9.79) minutes. In 50 W group, the single-turn isolation rate of bilateral PVI was 82.35%, while the ablation time was (1148.06±238.49) s, and the double-loop operation time was (36.24±7.75) minutes. Three patient (3/72) developed steam pop during operation without cardiac tamponade. The incidence of non-ablation-related complications was 2.78% (2/72) , while one patient developed vaginal bleeding after operation, and another patient developed femoral arteriovenous fistula, and received surgical treatment. Conclusion Based on AI or predicted AI, high-power (50-60 W) and short-duration radiofrequency ablation is a safe and efficient strategy for AF ablation, but long-term effectiveness and safety need to be further evaluated. Key words: Atrial fibrillation; Catheter ablation; Pulmonary vein isolation; High power; Ablation index