SPC365

Very high-power short-duration versus conventional radiofrequency ablation guided by ablation index for pulmonary vein isolation: data from a Portuguese Healthcare Centre

Session: Comunicações Orais - Sessão 03 - Fibrilhação auricular - Inovações no tratamento ablativo
Speaker: Rafael Silva Teixeira

Congress: CPC 2023
Topic: C. Arrhythmias and Device Therapy
Theme: 04. Arrhythmias, General
Subtheme: 04.4 Arrhythmias, General – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Rafael Silva Teixeira; Marta Catarina Almeida; Fábio Sousa Nunes; André Lobo; Marta Leite; Ana Inês Neves; Tiago Silva Martins; Diogo Santos; Mariana Brandão; Paulo Fonseca; João Gonçalves Almeida; Marco Oliveira; Ana Mosalina Manuel; Helena Gonçalves; João Primo; Ricardo Fontes-Carvalho

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Introduction:</span></span></span></strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> Very high-power short-duration (vHPSD) is a new modality of radiofrequency (RF) pulmonary vein (PVs) isolation which minimizes conductive heating while increasing resistive heating, delivering a targeted heating to the atrial wall and&nbsp;decreasing the probability of collateral tissue damage. vHPSD is expected to improve AF outcomes at the cost of narrower safety margin towards the oesophagus, shorter procedure times and less PVs reconnections based on insufficient non-transmural ablation lesions.</span></span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Aim:</span></span></span></strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> The aim of this study was to compare short-term duration outcomes of a vHPSD modality (90 Watt, 4 s) with a novel temperature-controlled RF catheter ablation system, with &lsquo;CLOSE&rsquo; protocol which uses a power-controlled RF catheter ablation system guided by the ablation index (AI), an arbitrary unit composed of power, contact force and ablation time. </span></span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Methods:</span></span></span></strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> We retrospectively analyzed short-term outcomes data from consecutive patients (pts) who were scheduled for first-do-symptomatic PVI since December 2021 and had a complete documentation of the technical procedure and follow-up (FUP) by month 3 after ablation in a ratio of 1 vHPSD to 1 CLOSE patient. Assessed outcomes included freedom from symptomatic AF recurrence at 3 months and procedure endpoints (first passage isolation (FPI) rate, total procedure time and total radiofrequency (RF) time and related procedure complications). </span></span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Results:</span></span></span></strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> We included 68 pts (mean age was 61 &plusmn; 10 years, 66% pts were male, mean body mass index 30&plusmn;4 kg/m<sup>2</sup>, 69% had paroxysmal AF). At the beginning of the ablation, 85% of pts undergoing CLOSE and 64% of pts undergoing vHPSD (p=0.10) were in sinus rhythm and electrical cardioversion was performed in 29% and 35% (p=0.80) in each group at some moment during the procedure, respectively. Ablation beyond PVI was performed in 18% of pts in each group. FPI rate was 75% in both groups (p=0.56). Total procedure time was significantly lower (p&lt;0.001) in pts submitted to vHPSD (110 &plusmn; 19 min) when compared to CLOSE (133 &plusmn; 26 minutes), as was total RF time (5 min, interquartile range (IQR) 4-6 min, in vHPSD, versus 23 min, IQR 22-19 min, in CLOSE). Fluoroscopic total time was similar between groups (p=0.508). Overall freedom from AF was found in 94% (vHPSD) vs. 85% (CLOSE), (p = 0.64). Only one minor vascular complication was documented in the post-procedure 24 hours in a patient&nbsp;submitted to vHPSD. </span></span></span></span></span></span></p>

<p style="text-align:start"><strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Conclusion:</span></span></span></strong><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> Our results from this small studied population suggest that vHPSD may shorten ablation procedure times without significantly increasing the rate of relevant intraprocedural complications or AF relapse in the first 3 months. </span></span></span><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:9pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> </span></span></span></span></span></span></p>