Safety and Efficacy of High-Power Short-Duration Radiofrequency Ablation (50W) in Patients with Paroxysmal Atrial Fibrillation

doi:10.21203/rs.3.rs-4895698/v1

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Safety and Efficacy of High-Power Short-Duration Radiofrequency Ablation (50W) in Patients with Paroxysmal Atrial Fibrillation

https://doi.org/10.21203/rs.3.rs-4895698/v1

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Background

Pulmonary vein isolation (PVI) using conventional power radiofrequency ablation (RFA) has been an effective treatment strategy for paroxysmal atrial fibrillation (PAF), but its longer duration may cause collateral damage to peripheral tissue. High-power RFA, characterized by better transmural performance and reduced collateral damage due to its shorter duration, has sparked a safety and efficacy controversy that still needs further evaluation.

Methods

In this retrospective cohort study, we included 259 patients with PAF who were had performed for lesion size index (LSI)-guided radiofrequency ablation. A total of 119 PAF patients underwent 50 W ablation. Complications and twelve-month arrhythmia-free outcomes of the procedure were compared with 140 patients who underwent 30–35 W ablation.

Results

PVI was successfully achieved in all patients. The procedural duration (140.3 ± 34.4 vs. 151.3 ± 40.6 min, P = 0.022) and overall radiation (112.0 ± 67.2 vs. 188.2 ± 119.2 mGy, P < 0.001) were significantly lower in the 50 W group. No major complications occurred in the high-power short-duration (HPSD) group. The recurrence of arrhythmia at the twelve-month follow-up was not significantly different between the two groups [11 (9.2%) vs. 19 (13.6%), P = 0.278)].

Conclusion

LSI-guided HPSD-RFA demonstrated comparable safety and efficacy for conventional ablation and resulted in reduced procedure time and radiation exposure.

Paroxysmal atrial fibrillation

High-power short-duration ablation

Pulmonary vein isolation

Radiofrequency ablation

Pulmonary vein isolation (PVI) was the core strategy of catheter ablation for the treatment of paroxysmal atrial fibrillation (PAF), which has been proven effective in clinical practice and can improve the quality of life in patients with PAF¹. Quantitative ablation guided by lesion size index (LSI), an integrated radiofrequency (RF) parameter that combines time, power and contact force (CF) into a weighted formula, could significantly improve the isolation rate of pulmonary vein potential^2,3,4. Conventional power (30 W-35 W) has been widely used in RF ablation of PAF. However, the long duration required for ablation may increase the conductive heating and radiation exposure both in surgeon and patients.

Mainly based on transient thermal impedance, high-power short-duration radiofrequency ablation (HPSD-RFA) irreversibly damaged the full-thickness pulmonary vein vestibular myocardium in a maximum proportion in a short period of time with a wider damage diameter, which could improve the continuity of the ablation lesions⁵. The HPSD-RFA group (45–50 W/8–15 s) had a lower acute pulmonary vein conduction recovery rate than the low power group (20–40 W/20–30 s), and the long-term pulmonary vein conduction recovery rate also deceased⁶. Moreover, the significantly shortened conductive heating phase may prevent injury to adjacent tissues by passive conductive heating and thermal latent effects. Recent study also reported that HPSD-RFA reduced AF recurrence in PAF patients after one year and had a low risk of esophageal injury⁷. Quantitative 50 W AF ablation has been suggested to be as safe as lower power and can realize reduced ablation and procedure time⁸. However, there was still debate regarding the application of HPSD methods. According to a recent study, adenosine stimulation after HPSD-RFA (50 W/6 ~ 10 s) still resulted in a high pulmonary vein conduction rate of 18%, lower than the expected response rate⁹. A meta-analysis of low-power long‐duration (LPLD) and HPSD ablation showed that the risks of recurrent atrial tachycardia and perioperative complications were not improved in the HPSD group¹⁰. These findings suggest that whether high-power RFA is better strategy than low-power RFA in PAF remains controversial. Therefore, utilization of LSI with powers 50 W and greater still needs to be validated in clinical settings.

In the present study, LSI-guided HPSD-RFA (50 W) was used for bilateral PVI in patients with PAF, and we compared these patients to a cohort using a conventional power (30–35 W). The recurrence of AF was investigated at the 12-month follow-up as well as the differences in the relationships between procedure time and complications in the two groups to help verify the intraprocedural safety and effectiveness of HPSD-RFA in PAF.

Study population

A total of 259 participants with PAF who were admitted to Nanfang Hospital of Southern Medical University between January 2017 and December 2021 and underwent radiofrequency ablation were included in the study (Supplemental Fig. 1). PAF was defined according to the most recent guidelines¹¹. RFA was performed by the same surgical team using the same 3D mapping system for all participants, and the selection of high and low power was sequential. The power of high-power RFA group is anterior wall power 50 W in anterior wall and also in other sites. The power of conventional power RFA group is 35 W in anterior wall and 30 W in other sites. Participants were enrolled consecutively and the follow-up was performed at 3-month intervals for all participants. The study excluded participants who had previously undergone unsuccessful ablation for PAF, participants who had accompanying cardiac thrombosis or complications with active hemorrhagic disease, participants who had vascular disease requiring surgical treatment and participants who had taken amiodarone within the 3 months preceding their admission. This study was in accordance with the principles of the Helsinki Declaration and was approved by the Medical Ethics Committee of Nanfang Hospital of Southern Medical University, and written informed consent was obtained from all participants before the ablation procedures.

Catheter ablation Procedure

Participants received anticoagulant therapy for 3 weeks before the ablation procedure and underwent preoperative transesophageal echocardiogram. The catheter ablation procedures were performed by three experienced surgeons who had completed 500 AF ablation cases. All procedures were performed under conscious sedation with fentanyl. The details of the operation are shown in Supplemental Fig. 1. Through the left or right femoral vein path, an 8F or 8.5F SL1 Swartz sheath and/or steerable sheath was placed in the left atrium (LA) following double transseptal punctures, and the pulmonary vein vestibule was determined by venography and/or three-dimensional mapping system (EnSite-Velocity 3000, Abbott Medical, USA) modeling. Pulmonary vein mapping was implemented using a multipole catheter (A-Focus, Abbott Medical). Radiofrequency ablation with a contact force (Tacticath Quartz, Abbott Medical) was enforced to achieve pulmonary vein isolation in the large wide area circumferential ablation on the left and right sides. After isolation, 10 minutes of observation was required to confirm PVI by using a multipole catheter. Additional ablation was recommended to induce isolation in the condition of conduction recovery. A saline irrigation rate of 15–30 mL/min was set in both groups and adjusted according to temperature and other feedback. In the HPSD group, automated lesion tagging (Automark algorithm, Abbott Medical, St Paul, MN) was used to guide point-by-point ablation in real time and settings as follows: 2.5 mm stability for 8 s, minimum 5 g contact force for > 80% time. The diameter of the ablation site was 4 mm, and the distance between adjacent ablation sites was required to be ≤ 4 mm. The LSI targets were ≥ 5.0 for the anterior wall, roof and inferior wall and ≥ 4.3 for the posterior wall. In the conventional group, the size and direction of the contact force were visible in the ablation process. Auto mark software was also used to guide real-time ablation. The catheter setting and related parameters were the same as those in the HPSD group. The end point of the procedure was to achieve bilateral pulmonary vein block. Intraoperative ablation intervention was recommended for clear non-pulmonary vein atrial fibrillation, typical atrial flutter and supraventricular tachycardia.

Participants follow-up and recurrence of AF

The enrolled patients were followed-up at 3, 6, 9 and 12 months after ablation to analyze the recovery of pulmonary vein potential and recurrence of atrial fibrillation. The procedural safety, characteristics and 1-year outcomes of the two groups were compared. Drug therapy was at the discretion of the clinician, but class I and III antiarrhythmic drugs were discontinued after 3 months when possible. Recurrence of an arrhythmia was considered to be any atrial arrhythmia (atrial fibrillation, atrial tachycardia and atrial flutter) that lasted more than 30 s after a 3-month blank. Patients were analyzed for 1-year arrhythmia-free survival in the case of no arrhythmias recorded at the last follow-up.

Statistics

Continuous variables were shown as the median with interquartile range (IQR) or mean with standard deviation. Categorical variables were expressed in terms of frequencies and percentages. The normality of the variable’s distribution was evaluated by using the Kolmogorov–Smirnov test. T-tests (continuous variables) and χ² tests were performed for univariate comparisons. Cumulative event incidence was shown by using the Kaplan–Meier curve. The event distribution between the two groups was compared by using the log-rank test. Cox proportional hazards regression models were used to assess the association between groups and recurrence of arrhythmias, reporting hazard ratios (HR) and 95% confidence intervals (CI). The multivariable Cox model was adjusted for baseline demographics (age and gender), left atrium and anti-coagulation drugs. All analyses were performed using SPSS version 20.0 (SPSS, Inc., Chicago, IL, USA) and R version 4 (R Foundation for Statistical Computing, Vienna, Austria). A two-sided P value of < 0.05 was considered statistically significant.

Baseline characteristics

A total of 259 participants were included in the final analysis (119 patients in the HPSD group, 140 participants in the conventional power group), with a mean age of 60.9 ± 10.7 years, 166 (64.1%) participants were male at baseline. The baseline characteristics of the population were shown in Table 1. The two groups were well matched in age, gender, body mass index (BMI), CHA2DS2-VASc score, left ventricular ejection fraction, cardiac structures (left atrial diameter and left ventricular end-diastolic diameter) (p > 0.05). There was also no significant difference in baseline clinical characteristics, including hypertension, coronary heart disease and diabetes, between the two groups (p > 0.05). However, compared with the conventional power group, the HPSD group had a higher bleeding risk score (1.06 ± 1.28 vs. 0.86 ± 0.88, p = 0.022) and inconsistent anticoagulant drugs (p < 0.001). The HPSD group had a lower proportion of warfarin use [3 (2.5%) vs. 16 (11.4%)]. Baseline participants characteristics between arrhythmia-free and arrhythmia groups over a 12-month follow-up were shown in Supplemental Table 1.

Table 1

Baseline participants characteristics
Baseline variables	Overall (n = 259)	Conventional power (n = 140)	High power (n = 119)	P Value
Age, yrs	60.9 ± 10.7	61.2 ± 9. 9	60.6 ± 11.6	0.685
Male, n (%)	166 (64.1)	91 (65.0)	75 (63.0)	0.841
BMI, kg/m²	24.1 ± 3.34	24.2 ± 3.33	24.1 ± 3.37	0.828
Medical history
Hypertension, n (%)	117 (45.2)	70 (50.0)	47 (39.5)	0.117
Diabetes, n (%)	31 (12.0)	15 (10.7)	16 (13.4)	0.629
CHD, n (%)	43 (16.6)	23 (16.4)	20 (16.8)	1.000
Renal Insufficiency, n (%)	9 (3.5)	5 (3.6)	4 (3.4)	1.000
DCM, n (%)	1 (0.4)	1 (0.7)	0 (0)	1.000
SSS, n (%)	3 (1.2)	2 (1.4)	1 (0.8)	1.000
Thromboembolism, n (%)	23 (8.9)	13 (9.3)	10 (8.4)	0.976
Atrioventricular Block, n (%)	6 (2.3)	5 (3.6)	1 (0.8)	0.223
LVEF, %	62.9 ± 6.17	62.7 ± 6.52	63.1 ± 5.75	0.550
LV size, mm	44.1 ± 4.09	44.1 ± 4.19	44.1 ± 3.99	0.974
LA size, mm	41.2 ± 5.23	41.4 ± 5.33	41.0 ± 5.12	0.545
RV size, mm	29.8 ± 4.16	30.1 ± 4.04	29.4 ± 4.29	0.176
RA size, mm	37.1 ± 5.20	37.4 ± 5.54	36.8 ± 4.79	0.371
HAS-BLED	0.95 ± 1.09	0.86 ± 0.88	1.06 ± 1.28	0.022
CHA2DS2-VASc	1.79 ± 1.54	1.86 ± 1.51	1.71 ± 1.58	0.458
Anticoagulant, n (%)				< 0.001
Dabigatran	76 (29.3)	41 (29.3)	35 (29.4)
Warfarin	19 (7.3)	16 (11.4)	3 (2.5)
Rivaroxaban	151 (58.3)	83 (59.3)	68 (57.1)
Non	5 (1.9)	0 (0)	5 (4.2)
Mitral Valve, n (%)				0.206
normal	34 (13.1)	22 (15.7)	12 (10.1)
mild	205 (79.2)	110 (78.6)	95 (79.8)
moderate to severe	20 (7.7)	8 (5.7)	12 (10.1)
Tricuspid Valve, n (%)				0.297
normal	32 (12.4)	21 (15.0)	11 (9.2)
mild	197 (76.1)	105 (75.0)	92 (77.3)
moderate to severe	30 (11.6)	14 (10.0)	16 (13.4)
Abbreviation: BMI, body mass index; CHD, coronary heart disease; DCM, dilated cardiomyopathy; SSS, sick sinus syndrome; LVEF, left ventricular ejection fraction; LV, left ventricular; LA, left atrium; RV, right ventricle; RA, right atrium.

Procedural characteristics

PVI was achieved successfully in all patients in both groups. Procedural data are shown in Table 2. The procedural duration was significantly lower in the HPSD group than in the conventional power group (140.3 ± 34.4 min vs. 151.3 ± 40.6 min, p = 0.022). Overall radiation was also significantly lower in the HPSD group than in the conventional power group (112.0 ± 67.2 mGy vs. 188.2 ± 119.2 mGy, p < 0.001) (Table 2 and Fig. 1).

Table 2

Procedural characteristics
Variables	Overall (n = 259)	Conventional power (n = 140)	High power (n = 119)	P Value
Complication, n(%)	5 (1.9)	5 (3.6)	0 (0)	0.064
Procedure Time, min	146.2 ± 38.2	151.3 ± 40.6	140.3 ± 34.4	0.022
Radiation, mGy	153.2 ± 105.7	188.2 ± 119.2	112.0 ± 67.2	< 0.001
Recurrent arrhythmia, n(%)	30 (11.6)	19 (13.6)	11 (9.2)	0.278
Survival time, day	334.9 ± 81.9	331.1 ± 82.4	339.3 ± 81.5	0.427

Complications and Outcomes

The complications observed in this study were shown in Table 2. No major complications occurred in the HPSD group. In the conventional power group, 5 participants developed complications, including hematoma, pseudoaneurysm, pericardial tamponade, slight pericardial effusion and aneurysm, all of which were managed conservatively. The main arrhythmia of recurrent patients was atrial fibrillation, which was 11 (9.2%) in the HPSD group and 19 (13.6%) in the conventional power group at the 1-year follow-up. The incidence of arrhythmia was lower in the HPSD group than in the conventional power group, but the results were not statistically significant (p = 0.278). Kaplan–Meier curves showed higher arrhythmia-free survival at the end of 12 months in the HPSD group than in the conventional power group, but the difference between the two groups was not statistically significant (Fig. 2, p = 0.25). Due to previous studies suggesting sex differences in almost all aspects of AF, we stratified by gender and found that the arrhythmia-free survival rate in the high-power group appeared to be higher in females, but without statistical significance (Fig. 3). The results were also similar after stratification by BMI, mitral valve status, tricuspid valve status and anti-coagulation strategy (Supplemental Figs. 2, 3, 4 and 5). Compared with the conventional power group, participants in the HPSD group had lower recurrence of arrhythmias risk with HR of 0.63 (95% CI, 0.30–1.34) in the multivariable model, although there was no statistically significant difference (Table 3, p = 0.23).

Table 3

Cox regression analysis: the association between the HPSD group and recurrence of arrhythmias
Group	Events No. (%)	Unadjusted HR (95% CI)	Adjusted HR (95% CI)
Conventional power	19 (13.6)	1(ref.)	1(ref.)
High power	11 (9.2)	0.65(0.31–1.36)	0.63(0.30–1.34)
P value		0.25	0.23
Adjusted for baseline demographics (age and gender), left atrium and anti-coagulation drugs.

Our present study compared the safety and efficacy of HPSD ablation (50 W) to conventional power (30–35 W) in patients with PAF. In terms of contact force (CF)–sensing catheters and PAF, this retrospective cohort study possessed the relatively large population in this field, and suggested that HPSD ablation saved total procedure time, significantly reduced the exposure to radiation in both operator and patient, and could be performed safely with no additional complications compared to the conventional power group. In terms of the recurrence rate of atrial fibrillation, the results were consistent in both groups.

Radiofrequency catheter ablation was one of the important measures for the treatment of PAF in recent years. Over the past decade, ablation success rates had increased with advancements in ablation techniques, especially after the introduction of contact force–sensing catheters. The mechanism of RF ablation was intricate, in which RF energy heating consists of two stages, the early resistive heating stage and the later conductive heating stage, while conductive heating was generally considered to cause deeper collateral damage. Compared to conventional power catheter ablation, HPSD-RFA was believed to damage tissues by resistive heating and can minimize the endocardial retention that may occur in an irrigated tip catheter heated at lower power⁵.

The high-power RF energy from the small electrodes heated the tissue immediately and rapidly by producing a high current¹². Based on the above situation, previous studies had consistently shown a shorter procedure time for HPSD-RFA¹³. Our study also demonstrated that the total operative time was significantly reduced in the HPSD group. A clear advantage of HPSD-RFA was revealed in our current study in reducing the time of intravenous fluid infusion and anesthesia by shortening the procedure time. Some studies had reported a statistically significant reduction in fluoroscopy time for HPSD-RFA, but others showed no difference¹⁰. Although the effect on fluoroscopy time was inconsistent in previous studies, our results suggested that HPSD could significantly reduce the exposure to radiation, which had a direct beneficial effect on the patient, operator and supporting personnel.

A prospective randomized controlled trial showed that HPSD ablation reduced the procedure time and also decreased the number of ablation lesions for PVI without increasing the incidence of complications¹⁴. HPSD ablation had also been shown to reduce the incidence of gaps between ablation sites and reduced the risk of atrial perforation caused by excessive transmural ablation¹⁵. Studies on HPSD that had been carried out in AF patients indicated that a catheter radiofrequency ablation power of 45 ~ 50 W was safe and effective^8,16. Our data also showed that HPSD had a relatively low incidence of complications, including no thromboembolic complications, pericardial tamponade and atrio-esophageal fistula, which was consistent with previous research. However, pulmonary vein reconnection following PVI remains a major clinical challenge. Using in vitro and in vivo models, Bhaskaran et al. demonstrated that, compared to the LPLD ablations, the lesion widths were similar and the lesion depths were shallower for the HPSD 50 W and 60 W ablations¹⁷. There was concern that the shallower lesions associated with HPSD may cause a higher recurrence rate of late arrhythmia compared to conventional power¹². We therefore observed the clinical outcomes of LSI-guided HPSD ablation at 12 months of follow-up and suggested that the 50 W group had a similar rate of being arrhythmia-free at 12 months compared to the conventional power group. It was worth mentioning that, we found that HPSD had a better prognosis for women with PAF, with a lower recurrence rate after ablation at 1 year follow-up, although there was no statistical difference compared to LPSD. Therefore, our existing data suggests that HPSD ablation is suitable for treating PAF in both males and females.

In general, our present study showed that HPSD-RFA was a safe and effective strategy for the treatment of patients with PAF. It was still necessary to include more patients with PAF and longer follow-up to determine the advantages of HPSD-RFA.

Study limitations

First, this study was a retrospective cohort, and patients were not prospectively recruited, but were sequentially selected. Second, Secondary pulmonary vein potential mapping was not performed in enrolled patients to reflect the recovery of pulmonary vein potential. Third, ablation parameters, including contact force, force–time-integral, and continuity (distance between adjacent ablation sites), were not compared between the two groups. We were unable to assess subclinical esophageal injury because routine esophageal endoscopy monitoring was not implemented in our study. Finally, systematic monitoring for recurrences after ablation was also required in future studies.

A population of patients with PAF was recruited for LSI-guided radiofrequency ablation, and the use of 50 W power was associated with a significant reduction in procedure time and radiation exposure and did not increase the risk of postoperative complications or AF recurrence. HPSD-RFA was a safe and effective treatment for PAF, multi-center studies and longer follow-up were needed to be further performed.

Conflict of interest disclosure

The authors declare they have no conflicts of interest.

Ethics declarations

Ethics approval and consent to participate

The protocol of the study was approved by Medical Ethics Committee at Nanfang Hospital of Southern Medical University. All patients gave written informed consents.

Clinical trial number

not applicable

Funding

This work was supported by a grant awarded to Y.W. from the Basic and Applied Basic Research Fund of Guangdong Province (no.2023A1515011833), and grants provided to X.L. from the Clinical Research Project of Nanfang Hospital (no. 2023CR028) and the Special Topic on Basic and Applied Basic Research of Guangzhou (no. 2023A04J2272).

Author Contribution

Concept/design (Xinzhong Li, Jianyong Li, Jianping Bin, Yuegang Wang), data collection (Xinzhong Li, Xiaobo Huang, Hairuo Lin, Senlin Huang), data analysis/interpretation (Zhiwen Xiao, Jiachen Zhang), drafting article (Xinzhong Li,Zhiwen Xiao, Yuegang Wang), critical revision of article (Jiachen Zhang, Xiaobo Huang, Hairuo Lin, Senlin Huang, Yulin Liao, Juefei Wu, Jiancheng Xiu, Jianyong L, Jianping Bin), approval of article (all of the authors).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon request.

Parameswaran R, Al-Kaisey AM, Kalman JM. Catheter ablation for atrial fibrillation: current indications and evolving technologies. Nat reviews Cardiol. 2021;18:210–25.
Das M, Loveday JJ, Wynn GJ, et al. Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values. Europace: European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society. Cardiol. 2017;19:775–83.
Whitaker J, Fish J, Harrison J, et al. Lesion Index-Guided Ablation Facilitates Continuous, Transmural, and Durable Lesions in a Porcine Recovery Model. Circulation Arrhythmia Electrophysiol. 2018;11:e005892.
Jankelson L, Dai M, Bernstein S, et al. Quantitative analysis of ablation technique predicts arrhythmia recurrence following atrial fibrillation ablation. Am Heart J. 2020;220:176–83.
Leshem E, Zilberman I, Tschabrunn CM, et al. High-Power and Short-Duration Ablation for Pulmonary Vein Isolation: Biophysical Characterization. JACC Clin Electrophysiol. 2018;4:467–79.
Castrejón-Castrejón S, Martínez Cossiani M, Ortega Molina M, et al. Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: short-term results of the POWER-FAST PILOT study. J interventional cardiac electrophysiology: Int J Arrhythm pacing. 2020;57:57–65.
Yavin HD, Bubar ZP, Higuchi K, et al. Impact of High-Power Short-Duration Radiofrequency Ablation on Esophageal Temperature Dynamic. Circulation Arrhythmia Electrophysiol. 2021;14:e010205.
O'Brien J, Obeidat M, Kozhuharov N, et al. Procedural efficiencies, lesion metrics, and 12-month clinical outcomes for Ablation Index-guided 50 W ablation for atrial fibrillation. Europace: European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society. Cardiol. 2021;23:878–86.
Ücer E, Jungbauer C, Hauck C, et al. The low acute effectiveness of a high-power short duration radiofrequency current application technique in pulmonary vein isolation for atrial fibrillation. Cardiol J. 2021;28:663–70.
Kewcharoen J, Techorueangwiwat C, Kanitsoraphan C, et al. High-power short duration and low-power long duration in atrial fibrillation ablation: A meta-analysis. J Cardiovasc Electrophys. 2021;32:71–82.
January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019;140:e125–51.
Bourier F, Duchateau J, Vlachos K, et al. High-power short-duration versus standard radiofrequency ablation: Insights on lesion metrics. J Cardiovasc Electrophys. 2018;29:1570–5.
Pambrun T, Durand C, Constantin M, et al. High-Power (40–50 W) Radiofrequency Ablation Guided by Unipolar Signal Modification for Pulmonary Vein Isolation: Experimental Findings and Clinical Results. Circulation Arrhythmia Electrophysiol. 2019;12:e007304.
Dhillon G, Ahsan S, Honarbakhsh S, et al. A multicentered evaluation of ablation at higher power guided by ablation index: Establishing ablation targets for pulmonary vein isolation. J Cardiovasc Electrophys. 2019;30:357–65.
Winkle RA, Mohanty S, Patrawala RA, et al. Low complication rates using high power (45–50 W) for short duration for atrial fibrillation ablations. Heart rhythm. 2019;16:165–9.
Shin DG, Ahn J, Han SJ, Lim HE. Efficacy of high-power and short-duration ablation in patients with atrial fibrillation: a prospective randomized controlled trial. Europace: European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society. Cardiol. 2020;22:1495–501.
Bhaskaran A, Chik W, Pouliopoulos J, et al. Five seconds of 50–60 W radio frequency atrial ablations were transmural and safe: an in vitro mechanistic assessment and force-controlled in vivo validation. Europace: European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society. Cardiol. 2017;19:874–80.

No competing interests reported.

Supplementaryappendix.docx
Binder14.png
Central Illustration. Safety and Efficacy of High-Power Short-Duration Radiofrequency Ablation in Patients with Paroxysmal Atrial Fibrillation. A total of 259 patients with paroxysmal atrial fibrillation underwent lesion size index (LSI)-guided radiofrequency ablation were enrolled. High-Power Short-Duration ablation reduced total procedure time, significantly decreased radiation exposure, and had similar recurrence rate of atrial fibrillation.

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Safety and Efficacy of High-Power Short-Duration Radiofrequency Ablation (50W) in Patients with Paroxysmal Atrial Fibrillation

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Abstract

Background

Methods

Results

Conclusion

Figures

Introduction

Methods

Study population

Catheter ablation Procedure

Participants follow-up and recurrence of AF

Statistics

Results

Baseline characteristics

Procedural characteristics

Complications and Outcomes

Discussion

Study limitations

Conclusion

Declarations

Conflict of interest disclosure

Ethics declarations

Clinical trial number

Funding

Author Contribution

Data availability statement

References

Additional Declarations

Supplementary Files

Status:

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