Novel very high-power short-duration ablation for pulmonary vein isolation ‘safe, effective’
A novel catheter for very high-power short-duration ablation for pulmonary vein isolation reduced procedure time with similar atrial fibrillation/atrial tachycardia recurrence at 1 year vs. standard ablation, researchers reported.
In addition, rates of successful first-pass ablation and adverse events were similar between the very high-power short-duration ablation arm and the control arm, according to the results of the FAST AND FURIOUS PVI study published in EP Europace.
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“In this study we evaluated the safety and efficacy of very high-power short-duration ablation for pulmonary vein isolation utilizing a very-close protocol in comparison with standard ablation. Pulmonary vein isolation solely utilizing very high-power short-duration ablation via a very-close protocol provides safe and effective procedures with a high rate of first-pass isolations,” Christian-H. Heeger, cardiologist and electrophysiologist at the University Heart Centre of the University Medical Center Schleswig-Holstein in Lübeck, Germany, told Healio. “Ablation of atrial fibrillation utilizing very high-power short-duration provides safe and effective pulmonary vein isolation. The procedure time and radiofrequency time was massively reduced.
“Although our study provides some data on pulmonary vein isolation durability, more data is necessary to draw final conclusions,” Heeger said.
The FAST AND FURIOUS PVI study
The novel ablation catheter (Qdot, Biosense Webster) was developed to allow for real-time assessment of temperature and temperature control, and according to the study, creates a shallower, wider lesion in a very short time and reduces collateral tissue damage. Due to the wider, shallower lesion, Heeger and colleagues adapted the close protocol to an even tighter “very close protocol of 3 mm to 4 mm of inter-lesion distance at the anterior and 5 mm to 6 mm at the posterior aspect of the left atrium using very high-power short-duration catheter ablation.
“3D-mapping and point-by-point-based [pulmonary vein isolation] received several improvements by implementing contact force sensing and ablation index (AI)-guided [radiofrequency] ablation shortening procedure time and improving safety and patients’ outcome. Recently, high-power short duration with a maximum of up to 50 W and very [high-power short duration] with a maximum of 90 W have been evaluated and were found to shorten the procedure duration,” Heeger and colleagues wrote.
To test its efficacy and safety, the researchers enrolled 50 consecutive patients with symptomatic AF to undergo very high-power short-duration catheter ablation for pulmonary vein isolation utilizing the very-close protocol and compared them with a control group of 50 patients who underwent ablation-index-guided strategy.
The target temperature in the very high-power short-duration ablation arm was 60° C based on the hottest surface thermocouple. According to the study, the irrigation flow rate delays the energy application for a minimum of 2 seconds before and 4 seconds after each radiofrequency application.
The primary endpoint was freedom from AF/atrial tachycardia recurrence at 12 months after pulmonary vein isolation, including a 90-day blanking period.
Very high-power short-duration ablation vs. standard ablation
The mean radiofrequency time in the very high-power short-duration ablation arm was 352 seconds and the mean procedure duration was 59 minutes compared with 1,657 seconds of radiofrequency time and a mean procedure duration of 101 minutes in the control arm (P for all < .0001).
The researchers reported that rate of first-pass isolation in the very high-power short-duration ablation arm was 74% compared with 76% in the control arm (P = .817).
Severe adverse events were reported in one patient in very high-power short-duration ablation arm and three patients in the control arm (P = .307).
Recurrence-free survival at 12 months was achieved in 78% of the very high-power short-duration ablation arm compared with 64% of the control arm (P = .142).
Durability of pulmonary vein isolation during redo procedures was 75% in the very high-power short-duration ablation arm compared with 33% in the control arm (P < .001).
“Although the number of single-shot devices for [pulmonary vein isolation] are increasing, the gold standard remains [radiofrequency]-based ablation,” Heeger and colleagues wrote.
“The advantages for single-shot devices are shorter procedure times, learning curves, and safety aspects,” they added. “Here, we are reporting on the efficacy and safety of [very high-power short-duration] based [pulmonary vein isolation] utilizing a very-close protocol as compared with standard [contact force]-sensing [ablation index]-guided [pulmonary vein isolation]. While demonstrating similar acute and long-term efficacy for [pulmonary vein isolation], the total ablation time, as well as procedural duration, were impressively low utilizing [very high-power short duration]. The data are promising and is comparable with the data of recent single-shot catheter ablation procedures.”
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