High‐power, short‐duration atrial fibrillation ablation compared with a conventional approach: Outcomes and reconnection patterns

Background The effectiveness, safety, and pulmonary vein (PV) reconnection patterns of point‐by‐point high‐power, short‐duration (HPSD) ablation relative to conventional force‐time integral (FTI)‐guided strategies for atrial fibrillation (AF) ablation are unknown. Objectives To compare 1‐year freedom from atrial arrhythmia (AA), complication rates, procedural times, and PV reconnection patterns with HPSD AF AF ablation versus an FTI‐guided low‐power, long‐duration (LPLD) strategy. Methods We compared consecutive patients undergoing a first ablation procedure for paroxysmal or persistent AF. The HPSD protocol utilized a power of 50 W and durations of 6–8 s posteriorly and 8–10 s anteriorly. The LPLD protocol was FTI‐guided with a power of ≤25 W posteriorly (FTI ≥ 300 g ·s) and ≤35 W anteriorly (FTI ≥ 400 g ·s). Results In total, 214 patients were prospectively included (107 HPSD, 107 LPLD). Freedom from AA at 1 year was achieved in 79% in the HPSD group versus 73% in the LPLD group ( p  = .339; adjusted hazard ratio with HPSD, 0.67; 95% confidence interval, 0.36–1.23; p  < .004 for non‐inferiority). Procedure duration was shorter in the HPSD group (229 ± 60 vs. 309 ± 77 min; p  < .005). Patients undergoing repeat ablation had a higher propensity for reconnection at the right PV carina in the HPSD group compared with the LPLD group (14/30 = 46.7% vs. 7/34 = 20.6%; p  = .035). There were no differences in complication rates. Conclusion HPSD AF ablation resulted in similar freedom from AAs at 1 year, shorter procedure times, and a similar safety profile when compared with an LPLD ablation strategy. Patients undergoing HPSD ablation required more applications at the right carina to achieve isolation, and had a significantly higher rate of right carinal reconnections at redo procedures.