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Very High-Power Short-Duration Ablation for Atrial Fibrillation in Adults With Congenital Heart Disease
Sarah Lengauer1, Nico Erhard1, Miruna A Popa1
1Department of Electrophysiology, German Heart Center Munich, TUM University Hospital, Munich, Bavaria, Germany.
Insights
Very high-power-short duration (vHPSD) ablation is safe for adult congenital heart disease patients with atrial fibrillation (AF). While effective for paroxysmal AF, outcomes for persistent AF were limited, with no procedure-related complications observed.
Area of Science:
- Cardiology
- Electrophysiology
- Congenital Heart Disease
Background:
- Limited data exists on very high-power-short duration (vHPSD) ablation for atrial fibrillation (AF) in adult congenital heart disease (ACHD) patients.
- Understanding the safety and long-term outcomes of this technique in ACHD is crucial.
Purpose of the Study:
- To evaluate the safety and effectiveness of vHPSD ablation for paroxysmal and persistent AF in ACHD patients.
- To assess procedural outcomes and long-term arrhythmia freedom.
Main Methods:
- Retrospective observational study of 66 consecutive ACHD patients undergoing vHPSD ablation.
- Circumferential pulmonary vein isolation (PVI) with additional substrate modification for persistent AF.
- Utilized irrigated radiofrequency (RF) energy with vHPSD settings (70W/5-7s or 60W/7-10s).
Main Results:
- Mean procedure time was 123.6 minutes; mean RF time was 18.19 minutes.
- No technique-related adverse events occurred; vascular access complications in 10.6% of patients.
- One-year freedom from AF off antiarrhythmic drugs was 58% (77.8% paroxysmal AF, 43.6% persistent AF).
Conclusions:
- vHPSD ablation is a safe and effective strategy for AF in ACHD patients, irrespective of congenital heart disease complexity.
- Excellent long-term outcomes were observed for paroxysmal AF after a single ablation.
- Results for persistent AF were less favorable, indicating a need for further research.
Introduction:
Data regarding safety and long-term outcome of very high-power-short duration (vHPSD) ablation in adult congenital heart disease (ACHD) patients with paroxysmal or persistent atrial fibrillation (AF) are lacking.
Methods:
Retrospective observational single-center study. The data of 66 consecutive ACHD patients (mean age 60 ± 12.8 years, 46% male) with mild (69.7%), moderate (22.7%), or complex (7.6%) congenital heart disease (CHD) who underwent ablation for paroxysmal (40.9%) or persistent AF (59.1%) were analyzed. Circumferential PVI was performed in all patients and additional substrate ablation in 79,4% of persistent AF patients using irrigated RF energy with vHPSD settings of 70 W/5-7 s or 60 W/7-10 s.
Results:
Mean procedure time was 123.6 ± 42 min with a mean RF time of 18.19 ± 10 min. No technique related adverse events occurred. Vascular access complications were detected in seven patients (10.6%) requiring intervention in four patients (6%). A median follow-up time of 491 days (IQR: 194-1054 days). Freedom from any atrial arrhythmia off antiarrhythmic drugs (AAD) at 1 year was present in 58% of patients (77.8% with paroxysmal AF, 43.6% with persistent AF).
Conclusion:
vHPSD for ablation of paroxysmal or persistent AF in ACHD patients is safe and effective. Regardless of CHD complexity, no vHPSD ablation modality related complications occurred. Long-term outcome for paroxysmal AF after one ablation was excellent whereas results for persistent AF were limited.
