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Biophysical Parameters of Pulmonary Vein Isolation with Very High-power Short-Duration Compared to Conventional Radiofrequency Ablation Guided by Ablation Index.
Session:
Sessão de Posters 31 - Fibrilhação auricular: dos mecanismos ao tratamento
Speaker:
Fabiana Duarte
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.8 Atrial Fibrillation - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Fabiana Silva Duarte; Rafael Silva-Teixeira; João Gonçalves Almeida; Paulo Fonseca; Marco Oliveira; Helena Gonçalves; João Primo; Ricardo Fontes-Carvalho
Abstract
<p>Introduction: Conventional strategies for pulmonary vein isolation (PVI) in atrial fibrillation (AF) involves point-by-point radiofrequency (RF) lesions with contact force-guided catheters. The very high-power short-duration (vHPSD) ablation uses a temperature-guided catheter at 90W for ≤ 4 seconds, aiming to reduce procedure time while maintaining efficacy. However, the specific procedural biophysical parameters contributing to successful atrial lesions remains unexplored.</p> <p>Aim: To compare vHPSD ablation parameters with conventional RF ablation guided by ablation index (AI).</p> <p>Methods: Retrospective single-center analysis included 88 patients (pts) scheduled for radiofrequency PVI since January 2022, with full documentation of technical aspects. Patients were divided according to power output used into AI-guided 35W (low-power; 13.6%) vs AI-guided 50W (high-power; 9.1%) vs vHPSD mode (77.3%). Energy applications were analyzed by left atrium ablation box localization: postero-inferior wall (PIW) and anterior wall and roof (AW/R).</p> <p>Results: In our cohort, median age was 61 years (IQR 51.9 – 67), with 29.5% female patients, a median body mass index of 25.59 kg/m2 and 78.5% with paroxysmal AF. No difference in baseline characteristics were observed between groups. Procedural data indicated a total mean procedure time of 91.9 ±10.6 min (p=0.274), with first-pass isolation ranging from 58% to 100% (p=0.15).<br /> Individual lesions in vHPSD group had significantly shorter duration compared to conventional groups, both in PIW (17.7±6 vs 11.1±3.3 vs 4±0.2 seconds, p<0.001) and AW/R (23.6±9.6 vs 15.4±5 vs 4±0.3s, p<0.001). Average contact force gradually increased with higher power delivery and shorter applications (12±5 vs 14±5 vs 15±8g, p<0.001). Maximum temperature achieved during ablation also increased with higher power delivery (31±10 vs 45±6 vs 50±4, p<0.001). In PIW ablation, impedance drop as a continuous variable was significantly superior in vHPSD (10±3 Ω) compared to low and moderate power applications (8±4 vs 10±5 Ω, p<0.001). Proportion of lesions with impedance drop > 10 Ω was higher in 50W and 90W groups (36% and 32%) vs. 35W group (21%, p<0.001).</p> <p>Conclusion: Higher power PVI allows for faster energy delivery with consequent reduction in ablation times. Shorter applications also minimize catheter instability, resulting in higher average contact force. The new generation temperature-guided catheter may therefore produce more effective lesions, as evaluated by higher rates of significant impedance drop, particularly in postero-inferior wall.</p>
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