Very high-power short-duration ablation for pulmonary vein isolation utilizing a very-close protocol-the FAST AND...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Atrial fibrillation (AF) necessitates effective pulmonary vein isolation (PVI) for treatment.
• Conventional ablation protocols have limitations in procedure time and efficacy.
• Very high-power short-duration (vHP-SD) radiofrequency ablation offers a novel approach to PVI.

Purpose of the Study:

• To evaluate the safety and efficacy of vHP-SD ablation for PVI using an individualized 'very-close protocol'.
• To compare the outcomes of vHP-SD PVI with a very-close protocol against standard ablation techniques.

Main Methods:

• Fifty patients with symptomatic AF underwent PVI using vHP-SD with a very-close protocol (3-4 mm anterior, 5-6 mm posterior inter-lesion distance).
• Outcomes were compared to a control group of 50 patients treated with an ablation-index-guided strategy.
• Key metrics included RF time, procedure duration, first-pass isolation rate, adverse events, 12-month recurrence-free survival, and PVI durability.

Main Results:

• The vHP-SD group demonstrated significantly shorter mean RF time (352 ± 81 s vs. 1657 ± 570 s) and procedure duration (59 ± 13 min vs. 101 ± 38 min) compared to the control group.
• First-pass isolation rates were comparable (74% vs. 76%).
• PVI durability assessed during redo procedures was significantly higher in the vHP-SD group (75% vs. 33%).

Conclusions:

• Pulmonary vein isolation solely utilizing vHP-SD via a very-close protocol is safe and effective.
• This approach results in significantly reduced procedure and ablation times.
• Promising 12-month follow-up and PVI durability support the potential of this technique.