High-power short-duration ablation results in significantly shorter procedure times without affecting procedural efficacy and safety among patients undergoing ablation for atrial fibrillation (AF).
This is according to the findings of a single-centre study investigating the impact of high-density mapping alongside high-power short-duration ablation protocols on the timing, efficacy and safety of the procedures, in which the investigators assessed three standardised setups.
Thomas Fink (Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany) and colleagues report the finding of their analysis in EP Europace, which involves ablation procedures in 307 patients undergoing AF ablation at their centre.
The use of higher energy settings in ablation catheters applied for a shorter duration of time are a recent development in practice, with analysis of ablation lesions having shown that shorter ablations with high energy lead to shallower and broader lesions with a high proportion of resistive instead of conductive heating.
Though preliminary research has shown that a high-power short-duration ablation strategy can be safe and effective, no head-to-head comparison of this approach versus traditional ablation protocols currently exists. In order to address this issue, Fink and colleagues systematically assessed the implementation of novel energy settings and the use of modern high-resolution mapping catheters in their institutional workflow for pulmonary vein isolation (PVI).
The investigators assessed three different settings: conventional ablation using 30/35W AI-guided ablation, used in cases performed before June 2021 (n=102); 50W AI-guided ablation for cases performed from June 2021 until November 2021 (n=102); and after November 2021, 90W/4 second ablation (n=103).
The researchers also documented peri- and intraprocedural steps starting from when the patient entered the electrophysiology lab, with six steps—preprocedural preparation, vascular access and transseptal puncture, left atrial mapping, ablation, validation of PVI and vascular closure and post-procedural preparation subjected to laboratory cycle analysis.
Findings of the study show that the mean “skin-to-skin” procedure duration was significantly different among the study groups, with 105.3±22.7 minutes in the 30/35W AI group, 81.4±2.3 in the 50W AI group, and 69.5±12.2 minutes in the 90W/4 second group. A total procedure duration (total laboratory time of the patient) of 132.8±42.1, 107.4±25.7 and 95.2±14 minutes was recorded for each of the groups respectively.
Fluoroscopy times, RF times and median duration of ablation applications were significantly different among study groups with the lowest numbers in the 90W/4 second group except for the number of RF applications, the investigators report. Additionally, the implementation of a high-density mapping catheter resulted in significant reduction of mapping times.
Arrhythmia recurrence was documented in 30 patients in the 30/35W group (29.4%), 26 patients in the 50W group (25.5%) and 26 patients in the 90W/4 group (25.2%), while repeat ablations were performed in 12, 9 and 6 patients in each of these groups.
“Implementation of high-density multi-polar mapping catheters and high-power short-duration ablation energy settings results in significant procedure shortening without affecting procedural efficacy and safety,” Fink and colleagues report. “Procedure duration is a result of reduction of mapping and ablation time intervals,” they note.
