High-power short-duration ablation index–guided pulmonary vein isolation protocol using a single catheter

BACKGROUND: Catheter ablation for atrial fibrillation (AF) is the most commonly performed electrophysiological procedure. To improve healthcare utilization, we aimed to compare the efficacy, efficiency, and safety of a minimalistic, streamlined single catheter ablation approach using a high-power short-duration ablation index–guided protocol (HPSD) vs. a control single-catheter protocol (SP). METHODS: Pulmonary vein isolation (PVI) with a single transseptal puncture without a multipolar mapping catheter was performed in 91 patients. Left atrial mapping was performed with the ablation catheter, only. Pacing maneuvers were used to confirm exit block. Procedural characteristics and success rates were compared using HPSD (n = 34) vs. a control (n = 57) ablation protocol. Freedom from recurrence was defined as a 1-year absence of AF episodes > 30 s, beyond the 3-month blanking period. RESULTS: Using the HPSD protocol the median procedure and RF ablation time were significantly shorter compared to the SP, 84 (IQR 76–100) vs. 118 min (IQR 104–141) and 1036 (898–1184) vs. 1949s (IQR 1693–2261), respectively, p < .001 for all. First-pass PVI was achieved using the HPSD protocol in 88% and using the SP in 87% of patients, p = 1.0. No procedural complications were observed. High-sensitivity cardiac troponin levels were significantly higher in patients using the HPSD protocol compared to the SP. At 12 months follow-up, 87% patients remained free from AF with no differences between groups. CONCLUSIONS: A minimalistic, HPSD ablation index–guided PVI with a single-catheter approach is very efficient, safe, and associated with excellent clinical outcomes at 1 year. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10840-022-01226-9.