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Published on: May 26, 2015
Posterior wall ablation for persistent atrial fibrillation: Very-high-power short-duration versus standard-power
Paolo Compagnucci1, Giovanni Volpato1,2, Laura Cipolletta1
1Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy.
Background:
Posterior wall ablation (PWA) is commonly added to pulmonary vein isolation (PVI) during catheter ablation (CA) of persistent atrial fibrillation (AF).
Objective:
The purpose of this study was to compare PVI plus PWA using very-high-power short-duration (vHPSD) vs standard-power (SP) ablation index-guided CA among consecutive patients with persistent AF and to determine the voltage correlation between microbipolar and bipolar mapping in AF.
Methods:
We compared 40 patients undergoing PVI plus PWA using vHPSD to 40 controls receiving PVI plus PWA using SP. The primary efficacy endpoint was recurrence of atrial tachyarrhythmias after a 3-month blanking period. The primary safety outcome was a composite of major complications within 30 days after CA. In the vHPSD group, high-density mapping of the posterior wall was performed using both a multipolar catheter and microelectrodes on the tip of the ablation catheter.
Results:
PVI was more commonly obtained with vHPSD compared to SP ablation (98%vs 75%; P = .007), despite shorter procedural and fluoroscopy times (P <.001). Survival free from recurrent atrial tachyarrhythmias at 18 months was 68% and 47% in the vHPSD and SP groups, respectively (log-rank P = .071), without major adverse events. The vHPSD approach was significantly associated with reduced risk of recurrent AF at multivariable analysis (hazard ratio 0.39; P = .030). Microbipolar voltage cutoffs of 0.71 and 1.69 mV predicted minimum bipolar values of 0.16 and 0.31 mV in AF, respectively, with accuracies of 0.67 and 0.88.
Conclusion:
vHPSD PWA plus PVI may be faster and as safe as SP CA among patients with persistent AF, with a trend for superior efficacy. Adapted voltage cutoffs should be used for identifying atrial low-voltage areas with microbipolar mapping.
Insights
Very-high-power short-duration (vHPSD) posterior wall ablation (PWA) plus pulmonary vein isolation (PVI) shows a trend for superior efficacy in persistent atrial fibrillation (AF) patients. This faster, safe approach may improve outcomes compared to standard-power ablation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Posterior wall ablation (PWA) is frequently combined with pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) catheter ablation (CA).
- Optimizing PWA techniques is crucial for improving AF management outcomes.
Purpose of the Study:
- To compare very-high-power short-duration (vHPSD) PWA plus PVI with standard-power (SP) ablation index-guided CA in persistent AF patients.
- To assess the correlation between microbipolar and bipolar mapping voltages during AF.
Main Methods:
- A comparative study of 40 patients undergoing vHPSD PWA + PVI versus 40 controls receiving SP PWA + PVI.
- Primary endpoints included atrial tachyarrhythmia recurrence and major complications post-CA.
- High-density mapping using multipolar and microelectrode catheters was employed in the vHPSD group.
Main Results:
- vHPSD achieved PVI more frequently (98% vs. 75%) with shorter procedural/fluoroscopy times.
- 18-month freedom from atrial tachyarrhythmias was 68% for vHPSD vs. 47% for SP (log-rank P = .071).
- vHPSD was associated with a reduced risk of recurrent AF (HR 0.39; P = .030) and showed no major adverse events.
Conclusions:
- vHPSD PWA plus PVI may offer a faster, safer, and potentially more effective alternative to SP CA for persistent AF.
- Specific voltage cutoffs derived from microbipolar mapping are recommended for identifying atrial low-voltage areas.
