Acute and long‐term efficacy of ablation index‐guided higher power shorter duration ablation in patients with atrial fibrillation: A prospective registry

BACKGROUND: Theoretically, targeting the same ablation index (AI) using higher power may achieve the same lesion size with a shorter ablation time. We evaluated the acute and long‐term efficacy of higher‐powered ablation guided by ablation index (HPAI) compared with conventional‐powered ablation guided by AI (CPAI) for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). METHODS: Drug refractory symptomatic AF patients who had been ablated with 40 W on the anterior/roof segments and 30 W on the posterior/inferior/carina segments were enrolled (HPAI group). We compared the HPAI group with the CPAI group who were ablated with 30 W on the anterior/roof segments and 25 W on the posterior/inferior/carina segments. The same AI was targeted (≥450 on the anterior/roof segments and ≥350 on the posterior/inferior/carina segments). We compared ablation time, acute pulmonary vein reconnection (PVR) and 1‐year AF recurrence between the two groups. RESULTS: A total of 118 patients were included (86 in the HPAI group and 32 in the CPAI group, paroxysmal AF, 73%). There was no significant difference in the acute PVR rate between the HPAI and the CPAI groups (3.7% vs. 4.2%, P = .580) with a 41% reduction in ablation time for PVI (38.7 ± 8.3 vs. 65.8 ± 13.7 minutes, P < .001). The 1‐year AF recurrence rate was not significantly different between HPAI and CPAI groups (12.8% vs. 21.9%, Log‐rank P = .242). There were no major complications in either group. CONCLUSIONS: Increased power during AF ablation, using the same AI targets, reduced the procedure and ablation times, and showed a comparable acute and long‐term outcome without compromising safety. CLINICAL TRIAL REGISTRATION: https://www.clinicaltrials.gov. Unique identifier: NCT 04379557.