High-Power Short-Duration Radiofrequency Application for Faster and Safer Pulmonary Vein Isolation: The POWER-FAST...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Optimal radiofrequency application (RFa) parameters for pulmonary vein isolation (PVI) remain under investigation.
• High-power short-duration (HPSD) RFa is explored as an alternative to conventional power delivery (CPD) for PVI.

Purpose of the Study:

• To compare the efficacy and safety of HPSD 70 W/9-10 s (HPSD-70) versus CPD (25-40 W) in patients undergoing PVI.
• To evaluate freedom from atrial arrhythmia recurrences and the incidence of esophageal thermal lesions (EDELs) as primary outcomes.

Main Methods:

• Randomized trial comparing HPSD-70 and CPD (25-40 W) for PVI.
• Primary outcomes: freedom from arrhythmia recurrence and EDELs at 12 months.
• Secondary outcomes included procedural times and embolic events.

Main Results:

• Noninferiority in arrhythmia recurrence freedom: 67% for HPSD-70 vs. 73.5% for CPD (P=0.28).
• Similar incidence of EDELs: 3.6% for HPSD-70 vs. 2.7% for CPD (P=0.94).
• HPSD-70 demonstrated shorter atrial dwell and RF times, but a numerical increase in embolic events (4 vs. 0).

Conclusions:

• HPSD-70 RFa is noninferior to CPD (25-40 W) for preventing arrhythmia recurrences after PVI.
• Esophageal thermal lesion incidence is similar between HPSD-70 and CPD.
• A trend towards higher embolic events with HPSD-70 warrants consideration.