Very high-power short-duration pulmonary vein isolation combined with anterior chest position of dispersive electrodes

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: Pulmonary vein isolation (PVI) is a cornerstone management of atrial fibrillation (AF). Very high-power short-duration (vHPSD) radiofrequency catheter ablation (RFCA) can accelerate PVI procedure. Recently, special attention has been paid to the position of dispersive electrodes (DE) for optimization of RFCA application. However, these two methods have not yet been combined in the setting of PVI. PURPOSE: To determine feasibility, safety, efficacy, and overall performance of vHPSD PVI with anterior chest position of DE. METHODS: Consecutive patients undergoing vHPSD PVI using flexible-tip catheter and anterior position of DE were included in the study. vHPSD protocol consisted of 70W RFCA applications lasting 4s. If needed, RFCA applications were extended using 50W until R-positive unipolar signal modification and/or until impedance drop ≥10% from baseline was achieved or were terminated in case of steam-pop occurrence. Demographical, clinical, procedural and follow-up data were collected. RESULTS: A total number of 43 patients (25 males, age 61±14years) were included in the study. 34 patients had paroxysmal AF (parox-AF group) and 9 patients had persistent AF (pers-AF group). Mean procedure time was 61±7min, mean RFCA time was 685±204s. All PVs were successfully isolated. Audible steam pops without sequele occurred in 6 (14%) cases. Major complications included one TIA without sequele. During follow-up 33 (77%) patients remained AF-free: 26 (76%) in parox-AF group vs 7 (78%) in pers-AF group (log rank p=0.0166). No atrioesophageal fistula or evidence of esophageal injury occurred. CONCLUSIONS: Anterior chest position of DE combined with vHPSD approach for PVI is feasible, appears safe and effective. More data on possible protective properties against atrioesophageal fistula occurrence using the presented approach is warranted.