Radiofrequency ablation of atrial fibrillation - 50 W or 90 W?

• Verfasst von: Müller, Julian [VerfasserIn]
• Verfasst von: Nentwich, Karin [VerfasserIn]
• Verfasst von: Ene, Elena [VerfasserIn]
• Verfasst von: Berkovitz, Artur [VerfasserIn]
• Verfasst von: Sonne, Kai [VerfasserIn]
• Verfasst von: Chakarov, Ivaylo [VerfasserIn]
• Verfasst von: Barth, Sebastian [VerfasserIn]
• Verfasst von: Waechter, Christian [VerfasserIn]
• Verfasst von: Behnes, Michael [VerfasserIn]
• Verfasst von: Akın, Ibrahim [VerfasserIn]
• Verfasst von: Halbfaß, Philipp [VerfasserIn]
• Verfasst von: Deneke, Thomas [VerfasserIn]
• Titel: Radiofrequency ablation of atrial fibrillation - 50 W or 90 W?
• Titelzusatz: original articles
• Verf.angabe: Julian Mueller, Karin Nentwich, Elena Ene, Artur Berkovitz, Kai Sonne, Ivaylo Chakarov, Sebastian Barth, Christian Waechter, Michael Behnes, Ibrahim Akin, Philipp Halbfass, Thomas Deneke
• E-Jahr: 2022
• Jahr: 19 September 2022
• Umfang: 10 S.
• Fussnoten: Gesehen am 20.06.2023
• Titel Quelle: Enthalten in: Journal of cardiovascular electrophysiology
• Ort Quelle: Oxford : Wiley-Blackwell, 1990
• Jahr Quelle: 2022
• Band/Heft Quelle: 33(2022), 12, Seite 2504-2513
• ISSN Quelle: 1540-8167
• DOI: doi:10.1111/jce.15681
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: atrial fibrillation
• Sach-SW: endoscopically detected esophageal lesion
• Sach-SW: prognosis
• Sach-SW: pulmonary vein isolation
• Sach-SW: very high-power short duration ablation
• K10plus-PPN: 183784125X

Abstract

Background: This study sought to evaluate the short and midterm efficacy and safety of the novel very high power very short duration (vHPvSD) 90 W approach compared to HPSD 50 W for atrial fibrillation (AF) ablation as well as reconnection patterns of 90 W ablations. Methods and Results: Consecutive patients undergoing first AF ablation with vHPvSD (90 W; predefined ablation time of 3 s for posterior wall ablation and 4 s for anterior wall ablation) were compared to patients using HPSD (50 W; ablation index-guided; AI 350 for posterior wall ablation, AI 450 for anterior wall ablation) retrospectively. A total of 84 patients (67.1 ± 9.8 years; 58% male; 47% paroxysmal AF) were included (42 with 90 W, 42 with 50 W) out of a propensity score-matched cohort. 90 W ablations revealed shorter ablation times (10.5 ± 6.7 min vs. 17.4 ± 9.9 min; p = .001). No major complication occurred. 90 W ablations revealed lower first pass PVI rates (40% vs. 62%; p = .049) and higher AF recurrences during blanking period (38% vs. 12%; p = .007). After 12 months, both ablation approaches revealed comparable midterm outcomes (62% vs. 70%; log-rank p = .452). In a multivariable Cox regression model, persistent AF (hazard ratio [HR]: 1.442, 95% confidence interval [CI]: 1.035-2.010, p = .031) and increased procedural duration (HR: 1.011, 95% CI: 1.005-1.017, p = .001) were identified as independent predictors of AF recurrence during follow-up. Conclusions: AF ablation using 90 W vHPvSD reveals a similar safety profile compared to 50 W ablation with shorter ablation times. However, vHPvSD ablation was associated with lower rates of first-pass isolations and increased AF recurrences during the blanking period. After 12 months, 90 W revealed comparable efficacy results to 50 W ablations in a nonrandomized, propensity-matched comparison.