Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation.

Kottmaier, Marc; Popa, Miruna; Bourier, Felix; Reents, Tilko; Cifuentes, Jairo; Semmler, Verena; Telishevska, Martha; Otgonbayar, Ulamnemekh; Koch-Büttner, Katharina; Lennerz, Carsten; Bartkowiak, Marcin; Kornmayer, Marielouise; Rousseva, Elena; Brkic, Amir; Grebmer, Christian; Kolb, Christoph; Hessling, Gabriele; Deisenhofer, Isabel

doi:10.1093/europace/euz342

journal article

Document type:: Article; Journal Article
Author(s):: Kottmaier, Marc; Popa, Miruna; Bourier, Felix; Reents, Tilko; Cifuentes, Jairo; Semmler, Verena; Telishevska, Martha; Otgonbayar, Ulamnemekh; Koch-Büttner, Katharina; Lennerz, Carsten; Bartkowiak, Marcin; Kornmayer, Marielouise; Rousseva, Elena; Brkic, Amir; Grebmer, Christian; Kolb, Christoph; Hessling, Gabriele; Deisenhofer, Isabel
Title:: Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
Abstract:: AIMS: Pulmonary vein isolation (PVI) using radiofrequency ablation (RFA) in patients with paroxysmal atrial fibrillation (PAF) is effective but hampered by pulmonary vein reconnection due to insufficient ablation lesions. High-power delivery over a short period of time (HPSD) in RFA is stated to create more efficient lesions. The aim of this study was to compare intraprocedural safety and outcome of HPSD ablation to conventional power settings in patients undergoing PVI for PAF. METHODS AND RESULTS: We included 197 patients with PAF that were scheduled for PVI. An ablation protocol with 70 W and a duration cut-off of 7 s at the anterior left atrium (LA) and 5 s at the posterior LA (HPSD group; n = 97) was compared to a conventional power protocol with 30-40 W for 20-40 s (standard group; n = 100) in terms of periprocedural complications and a 1-year outcome. The HPSD group showed significantly less arrhythmia recurrence during 1-year follow-up with 83.1% of patients free from atrial fibrillation compared to 65.1% in the standard group (P < 0.013). No pericardial tamponade, periprocedural thromboembolic complications, or atrio-oesophageal fistula occurred in either group. Mean radiofrequency time (12.4 ± 3.4 min vs. 35.6 ± 12.1 min) and procedural time (89.5 ± 23.9 min vs. 111.15 ± 27.9 min) were significantly shorter in the HPSD group compared to the standard group (both P < 0.001). CONCLUSION: High-power short-duration ablation demonstrated a comparable safety profile to conventional ablation. High-power short-duration ablation using 70 W for 5-7 s leads to significantly less arrhythmia recurrences after 1 year. Radiofrequency and procedural time were significantly shortened.
Journal title abbreviation:: Europace
Year:: 2020
Journal volume:: 22
Journal issue:: 3
Pages contribution:: 388-393
Fulltext / DOI:: doi:10.1093/europace/euz342
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31872249
Print-ISSN:: 1099-5129
TUM Institution:: Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (Prof. Schunkert)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Kreislauferkrankungen im Erwachsenenalter (DHM) (Prof. Schunkert)2020