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Funding Acknowledgements Type of funding sources: None. Background Catheter ablation for atrial fibrillation (AF) is the most common performed electrophysiological procedure. The cost of this procedure remains high. Purpose To improve health care utilization, we aimed to compare the efficacy and safety of a minimalistic, streamlined single radiofrequency catheter ablation approach using high power short duration ablation-index guided protocol (HPSD) vs. a standard single catheter protocol. Methods A circular mapping catheter free PVI with a single transseptal puncture was performed in 91 patients. A CARTO fast anatomical map was performed with the ablation catheter. Pacing maneuvers were used to confirm exit block. Procedural characteristics and success rates were compared using HPSD- vs. a standard ablation-protocol. Freedom from recurrence was defined as a 1-year absence of AF episodes &amp;gt; 30 s, beyond the 3-month-blanking-period. Results Using the HPSD-protocol the median procedure, map and RF ablation time were significantly shorter in the HPSD group compared to the standard group, 84 (IQR 76-100) vs. 118 minutes (IQR 104-141), 12 (IQR 10-16) vs. 18 minutes (IQR 15-21) and 1036 (898-1184) vs. 1949 seconds (IQR 1693-2261), respectively, P &amp;lt; .001 for all. First-pass-PVI was achieved using the HPSD-protocol in 23 patients (74%) and the standard-protocol in 30 patients (53%), p = 0.08. Localization of conduction gaps are illustrated for the HPSD-protocol and the standard-protocol in Figure 1. The residual gap was identified using the ablation catheter only in all patients. No procedural complication were observed. At 12 months follow-up, 60 (89.6%) patients remained free from AF with no differences between groups. Conclusions A minimalistic, CMC-free HPSD-guided PVI approach is very efficient, safe, likely cost-saving, and associated with excellent clinical outcomes at 1 year. Abstract Figure 1

Efficacy and safety of a high power short duration ablation-index guided protocol for pulmonary vein isolation using a single catheter