Single-center outcome after ablation of atrial fibrillation using very high-power short duration pulmonary vein isolation

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. BACKGROUND: Catheter ablation of atrial fibrillation is (AF) an established second line therapy for patients with symptomatic paroxysmal (PAF) and persistent AF (persAF). Novel ablation catheters with integrated thermocouples allow fast application of radiofrequency lesions with powers up to 90W. We aimed to describe primary and secondary outcomes after very high-power short duration (vHPSD) ablation. METHODS: 201 consecutive patients (127 PAF, 68 persAF, 6 longstanding persistent AF) underwent pulmonary vein isolation (PVI) using the QDOT Micro Catheter (Biosense Webster) with the ablation mode QMODE+ (90W, 4s, interlesion distance ≤4mm anterior, ≤6mm posterior). RESULTS: Mean age was 62±10 years, 38% were female, median CHA2DS2-VASc Score was 2 (0, 7). Median follow up duration was 196 (30, 461) days. 35% of patients had additional ablation of typical right atrial flutter. Primary success rate to achieve pulmonary vein isolation was achieved in all patients, no catheter-related complications (e.g., charring, steam pop) occurred. First pass isolation of all 4 PVs was achieved in 53% of patients, re-ablations were necessary in the carina regions (right: 27% of cases, left: 20%), 34% at multiple regions including the ridge, 12% in other regions around the PVs. Median procedure for PVI only were 110 (36-344) minutes. Arrhythmia-free survival was 79,3%. 21 patients underwent re-do procedures during follow-up showing most commonly showing gaps in the right PVs (RSPV 52%, RIPV 43%), the left inferior PV (48%), as well as the LSPV (38%) and the ridge (24%); with 91% of patients with recurrence showing more than one site reconnected. CONCLUSION: Very high-power short duration ablation allows safe and quick pulmonary vein isolation. However, first pass isolation rate is low due to gaps in the carina regions. Arrhythmia-free survival is comparable to other pulmonary vein isolation techniques.