High-power, short duration radiofrequency ablation may achieve pulmonary vein isolation faster in AF

Pulmonary vein isolation is a common procedure to treat atrial fibrillation (Afib). Atrial fibrillation is an abnormal heart rhythm (arrhythmia) that occurs in the atrium. When left untreated, atrial fibrillation can lead to consequences such as stroke and heart attack.

High-power, short duration (HPSD) radiofrequency ablation (RFA) is a commonly used strategy for pulmonary vein isolation (PVI). A study suggests HPSD is reliable method to achieve pulmonary vein isolation compared to standard power, standard duration RFA but is an increased risk of Asymptomatic Cerebral Emboli (ACE).

A recent study aimed to compare HPSD with standard power, standard duration (SPSD) RFA in patients undergoing PVI. The study is published in JACC: Clinical Electrophysiology.

Researchers included patients with paroxysmal or persistent (<1 year) atrial fibrillation (AF) were randomized to HPSD (50 W) or SPSD (25-30 W) RFA to achieve PVI. Outcomes assessed included time to achieve PVI (primary), left atrial dwell time, total procedure time, first-pass isolation, Pulmonary Vein (PV) reconnection with adenosine, procedure complications including asymptomatic cerebral emboli (ACE), and freedom from atrial arrhythmias.

The key findings of the study are

• A total of Sixty patients (median age 66 years; 75% male) with paroxysmal (57%) or persistent (43%) AF were randomized to HPSD (n = 29) or SPSD (n = 31).

• Median time to achieve PVI was shorter with HPSD vs SPSD (87 minutes vs 126 minutes; P = 0.003), as was left atrial dwell time (157 minutes vs 180 minutes; P = 0.04).

• There were no differences in first-pass isolation (79% vs 76%; P = 0.65) or PV reconnection with adenosine (12% vs 20%; P = 0.26) between groups.

• At 12 months, recurrent atrial arrhythmias occurred less in the HPSD group compared with the SPSD group (n = 3 of 29 [10%] vs n = 11 of 31 [35%]; HR: 0.26; P = 0.027).

• There was a trend toward more ACE with HPSD RFA (40% HPSD vs 17% SPSD; P = 0.053).

Researchers concluded that “In patients undergoing AF ablation, HPSD compared with SPSD RFA results in shorter time to achieve PVI, greater freedom from AF at 12 months, and a trend toward increased ACE.”

Reference: Lee A, Voskoboinik A, Cheung C, et al. A Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation. J Am Coll Cardiol EP. 2023 Jul, 9 (7_Part_2) 1038–1047.https://doi.org/10.1016/j.jacep.2022.12.020.