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Comparison of standard-power and very high-power short-duration pulmonary vein ablation
Session:
SESSÃO DE POSTERS 41 - ABLAÇÃO DE FIBRILHAÇÃO AURICULAR
Speaker:
Inês Rodrigues
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Inês Arrobas Rodrigues; António Gonçalves; Marta Almeida; André Lobo; Rafael Teixeira; Mafalda Carrington; Marco Oliveira; Helena Gonçalves; João Primo; João Almeida; Paulo Fonseca; Ricardo Fontes-Carvalho
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) catheter ablation and is commonly performed using radiofrequency (RF) energy. Novel catheters using shorter but higher-power RF applications can improve lesion quality and reduce procedural time compared to the standard approach, while ensuring similar clinical and safety outcomes.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study aims to compare very high-power short-duration (vHPSD) AF ablation with a matched control cohort undergoing standard power and duration (SPD) AF ablation at our centre regarding clinical outcomes, procedural efficiency and safety.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All patients who underwent first PVI using catheter ablation at our centre between January 2021 and May 2024 were included. SDP AF ablation (35W RF applications guided by Ablation Index) was performed until April 2022, after which vHPSD AF ablation (90W/4s) became the standard approach through the study’s conclusion. The two groups were matched using a propensity score analysis and then compared regarding freedom from AF recurrence, procedural efficiency, and safety. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">308 patients were submitted to IVP, and after the propensity score analysis, 210 patients were analysed (64,8% male, median age 62 years (IQR 54,7–67,5)). There were 105 patients in each group with comparable baseline characteristics. The median follow-up time was 364 days (IQR 207–548) for the vHPSD group and 729 days (IQR 559–730) for the STD group. Freedom from AF recurrence at 12 months was similar between groups in the survival analysis (86,6% vs 88,4%, p=0,510) (<strong>Graphic 1</strong>). Total procedural time, ablation time, and RF application time were significantly shorter in the vHSPD arm (86,5min vs 100,0min, p<0,001; 32,0min vs 45min, p<0,001, and 7min vs 24,5min, p<0,001, respectively). PV first-pass isolation (FPI) was obtained in 54,5% of patients in the vHPSD group and 72,0% in the SPD group (p=0,004). Overall, AF catheter ablation had a favourable safety profile, with a low prevalence of adverse effects, irrespective of the type of RF energy used (one pericardial effusion in the vHPSD group and one pericarditis in the SDP group). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">VHPSD AF ablation proved to be a more efficient technique with a shorter procedural time, achieving similar clinical outcomes despite having a lower FPI rate. Both procedures appeared to be safe with low prevalence of adverse effects. </span></span></p>
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