High-power short-duration AF ablation modestly reduces procedure time
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A novel catheter for very high-power short-duration ablation for pulmonary vein isolation in patients with atrial fibrillation modestly reduced procedure time compared with standard ablation, according to data from the POWER PLUS trial.
High-power short-duration ablation for pulmonary vein isolation with the novel catheter (QDot, Biosense Webster) was associated with similar safety and 6-month efficacy compared with standard pulmonary vein isolation, according to the researchers.
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For the POWER PLUS trial, the researchers randomly assigned 180 patients with paroxysmal or persistent AF (mean age, 63 years; 67% men) undergoing first-time pulmonary vein isolation to receive very high-power short-duration ablation (90 W over 4 seconds) or standard ablation (35 to 50 W applications titrated to an ablation index > 550 anteriorly and > 400 posteriorly).
The outcomes of interest were procedural efficiency, defined as procedure time and first-pass isolation; safety including an esophageal endoscopic evaluation; and 6-month effectiveness assessed by repetitive Holter monitoring.
Procedure time was shorter in the very high-power short-duration group compared with the standard group (70 minutes vs. 75 minutes; P = .009), Louisa O’Neill, MD, PhD, cardiologist at AZ Sint-Jan Hospital, Bruges, Belgium, and colleagues wrote.
There was a trend toward lower rates of first-pass isolation in the very high-power short-duration group (83.9% vs. 90%; P = .0852), according to the researchers.
There were no major complications in either group, and esophageal injury occurred in one patient from each group, the researchers wrote.
The rates of recurrent arrhythmia at 6 months were 17% in the very high-power short-duration group and 15% in the standard group (P = .681), according to the researchers.
“In the future, a hybrid CLOSE approach combining contiguous 90-W/4-seconds applications with conventional applications in regions of catheter instability and/or increased tissue thickness may offer the optimal balance of procedural efficiency and efficacy,” O’Neill and colleagues wrote.
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