High-power short-duration (HP-SD) ablation may improve pulmonary vein isolation (PVI) durability and shorten radiofrequency ablation time, according to research presented May 5 at the 2020 Heart Rhythm Scientific Sessions and simultaneously published in JACC: Clinical Electrophysiology.

Hagai D. Yavin, MD, et al., compared the acute safety and long-term lesion durability between HP-SD (45-50 W for 8-15 sec) and moderate-power moderate-duration (MP-MD) (20-40 W, 20-30 sec) ablation for the treatment of atrial fibrillation (AFib), including PVI and linear ablation. 

Results showed that of the 112 patients with symptomatic paroxysmal or persistent AFib included in this prospective single-center study, the rate of PVI at the completion of the initial encirclement was similar between HP-SD ablation and MP-MD ablation in 112 historical controls (90.2% vs. 83%; p=0.006). However, the authors found the HP-SD strategy required shorter radiofrequency time (17.2 min vs. 31.1 min; p<0.001). 

Furthermore, the incidence of chronic PV reconnection was found to be lower with HP-SD ablation, and in a higher proportion of HP-SD applications, catheter motion was less than 1 mm during 50% or more of application duration, allowing energy delivery with greater stability.

The authors found that both ablation strategies were effective for cavotricuspid isthmus; however, high-power short-duration was less effective for mitral annular line, requiring ablation at lower powers for longer durations to avoid steam pops.

In an accompanying editorial comment, Felix Bourier, MD, and Philipp Sommer, MD, note this study "presents data on the effect of high-power short-duration on midterm outcome, but also highlights the importance of catheter stability on lesion formation and the rate of chronic pulmonary vein isolations." They add, "More and more data seem to justify that different patients may need different treatment strategies – and this may not only be true in terms of where to deploy the lesions but also in how to deploy the lesions."

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Pulmonary Veins, Atrial Fibrillation, Prospective Studies, Catheter Ablation, Electrophysiology

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