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Optimized workflow for pulmonary vein isolation using 90-W radiofrequency applications: a comparative study.

Agustín Alfonso Bortone1, F Daniel Ramirez2,3, Stéphane Combes4

  • 1Service de Cardiologie, Hôpital Privé Les Franciscaines, ELSAN, Nîmes, France. agubene@hotmail.com.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|August 28, 2023
PubMed
Summary

A combined 90-50 W strategy for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF) did not show improved safety or effectiveness. This approach was compared to a 50 W-only ablation index (AI)-guided PVI strategy.

Keywords:
Ablation indexCombined strategyParoxysmal atrial fibrillationPulmonary vein isolationRadiofrequencyVery high-power short-duration

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Area of Science:

  • Electrophysiology
  • Cardiology
  • Medical Device Technology

Background:

  • Ninety-watt applications in pulmonary vein isolation (PVI) create shallower lesions than 50-W applications, potentially impacting efficacy.
  • Catheter instability and lesion characteristics are critical factors in PVI strategies.
  • A novel combined (90-50 W) PVI approach was developed considering these factors.

Purpose of the Study:

  • To prospectively compare a combined (90-50 W) PVI strategy against a 50 W-only ablation index (AI)-guided PVI strategy.
  • To evaluate the safety, efficiency, and effectiveness of the two PVI strategies in patients with paroxysmal atrial fibrillation (AF).

Main Methods:

  • 150 consecutive paroxysmal AF patients underwent PVI using CARTO under general anesthesia.
  • Group 1 (n=75): Combined (90-50 W) strategy with QDOT-MICRO catheter (90 W for posterior LA wall, 50 W elsewhere).
  • Group 2 (n=75): 50 W-only AI-guided strategy with SmartTouch-SF catheter.

Main Results:

  • Both groups exhibited similar clinical characteristics, LA dimensions, procedural times, and first-pass PVI rates.
  • Acute PV reconnection rates were low (0% vs 6.6%, P=0.05) and 1-year SR maintenance was comparable (93.3% vs 90.6%, P=0.57).
  • The combined strategy group reported no complications, while the 50 W-only group had 2 groin hematomas.

Conclusions:

  • A combined (90-50 W) PVI strategy did not demonstrate superior safety, efficiency, or effectiveness compared to a 50 W-only AI-guided strategy in paroxysmal AF patients.
  • The findings suggest that the combined strategy offers no significant advantage over the established 50 W-only AI-guided approach.
  • Further research may explore optimized parameters for combined power strategies in PVI.