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Clinical and procedural outcomes of very high-power short-duration vs. standard power ablation for pulmonary vein isolation

Year: 2026

Type: article

Abstract: Introduction Pulmonary vein isolation (PVI) using shorter but higher-power radiofrequency (RF) applications can improve lesion quality and reduce procedural time compared to the standard approach, while ensuring similar clinical and safety outcomes. The aim of this study was to compare very high-power short-duration (vHPSD) with standard-power atrial fibrillation (AF) ablation regarding clinical outcomes, procedural efficiency and safety. Methods All patients who underwent first PVI using RF energy between January 2021 and June 2024 were included. The two groups (standard-power vs. vHPSD AF ablation) were matched using a propensity score analysis and compared at 12 months regarding freedom from AF recurrence, quality of life improvement and safety. Results 333 patients were submitted to PVI, and after the propensity score analysis, 226 patients were analysed (65.0% male, median age 62.8 years, comparable baseline characteristics). The median follow-up time was 554 days (IQR 351, 729) for the vHPSD group and 728 days (IQR 555, 730) for the standard group ( p < 0.01). Freedom from AF recurrence at 12 months was similar between groups (83.7% vs. 86.1%, p = 0.85) and both groups exhibited significant and similar improvements in QoL measurements, following the procedure (mean adjusted difference of +13.9, 95% CI 10.4-17.5, p < 0.001). Total procedural time was significantly shorter in the vHPSD arm (86.5 min vs. 100.0 min, p < 0.01) and PV first-pass isolation (FPI) was significantly lower in the vHPSD group (52.3% vs. 72.3%, p < 0.01). AF catheter ablation had a favourable safety profile, with a low prevalence of adverse effects, irrespective of the type of RF energy used. Conclusion VHPSD AF ablation was a more efficient technique with a shorter procedural time, achieving similar clinical outcomes despite having a lower FPI rate. Both techniques appeared to be safe with low prevalence of adverse effects.

Source: Frontiers in Cardiovascular Medicine

DOI: 10.3389/fcvm.2026.1806509