Work

Optimal strategy for very high-power short-duration atrial fibrillation ablation: Acute efficacy and safety of pulmonary vein and box isolation

Year: 2025

Type: article

Abstract: The optimal strategy for very high-power short-duration (vHPSD) ablation for atrial fibrillation (AF) is unclear. Data regarding the application of box isolation (BOXI) and its complications, particularly, pulmonary vein stenosis (PVS), remain scarce. We aimed to determine the optimal strategy for vHPSD in AF ablation by focusing on pulmonary vein isolation (PVI) and BOXI and assessing the acute efficacy and safety. Patients with drug-refractory AF (n = 97) were divided into two groups: Strategy 1 (n = 50; 90 W for 4 s with PVI for the bottom line and 50 W with an ablation index [AI] of 450 for the roof line) and Strategy 2 (n = 47; based on the outcomes of Strategy 1, using AI-guided ablation). The acute efficacy and safety were compared between the groups. Pre- and post-ablation imaging was conducted to assess PVS. Strategy 1 yielded first-pass isolation (FPI) rates of 62.5 % (PVI) and 72 % (BOXI). The weak points were the thick parts of the atrial wall and the parts with epicardial connections. Strategy 2, which was improved by AI guidance, increased the FPI rates to 97.5 % (PVI) and 95 % (BOXI) and reduced the procedural and fluoroscopy times, respectively. Follow-up imaging showed that the PVS incidence remained low and did not significantly differ between the strategies. AI-guided ablation enhanced the efficacy of vHPSD for PVI and BOXI in Strategy 2. Furthermore, our assessment of PVS demonstrated that vHPSD maintains a favorable safety profile with a low PVS incidence. Very high-power short-duration ablation for Atrial fibrillation: Efficacy and Safety Key results: This study compares two strategies for very high-power short-duration ablation in atrial fibrillation. Strategy 2, using AI-guided ablation, significantly improved first-pass isolation rates and reduced both procedure and fluoroscopy times compared to Strategy 1, while maintaining safety. • Strategy 1 yielded first-pass isolation rates of 62.5 % (PVI) and 72 % (BOXI). • Weak points were thick parts of the atrial wall/those with epicardial connections. • Strategy 2 increased the FPI rates to 97.5 % (PVI) and 95 % (BOXI). • Strategy 2 reduced the procedural and fluoroscopy times. • PVS incidence remained low and did not significantly differ between the strategies.

Source: Indian Pacing and Electrophysiology Journal

DOI: 10.1016/j.ipej.2025.04.007

Authors: Yusuke Sakamoto, Hiroyuki Osanai, Yoshihito Nakashima, Hiroshi Asano, Masayoshi Ajioka

Institution: Tosei General Hospital

Language: English

Topic: Atrial Fibrillation Management and Outcomes

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $550