Very high-power short-duration ablation for superior vena cava isolation in patients with recurrent atrial...

Superior vena cava isolation (SVCI) has been proposed as a treatment for non-pulmonary vein triggers of atrial fibrillation (AF). Recently, high-power short-duration ablation has emerged as a potential strategy for SVCI, although the optimal settings remain undetermined, particularly in the lateral region. Specifically, the QDOT MICRO™ (Biosense Webster, Irvine, CA, USA) system enables very high-power, short-duration (vHPSD, 90 W for 4 s) ablation, achieving a shallower tissue depth than conventional methods. In this study, we aimed to compare the effectiveness of vHPSD with a conventional strategy (20 W, ablation index of 240) using the Thermocool SmartTouch® Surround Flow (Biosense Webster) system in patients with AF.

We retrospectively analyzed 100 consecutive patients with recurrent AF post-initial pulmonary vein isolation who underwent SVCI using either the vHPSD or 20 W strategy at our institution between January 2016 and October 2024. Outcome measures included SVCI procedure time, number of application points, the incidence of gaps in each segment, and associated complications.

There were 40 participants in the vHPSD group and 60 in the 20 W group. The vHPSD group showed significantly shorter SVCI procedure time than the 20 W group (11 ± 5.5 vs. 16 ± 9.6 min, p < 0.01) and required fewer application points (21 ± 7.6 vs. 29 ± 12, p < 0.01). The incidence of gaps in the lateral segments was significantly lower in the vHPSD group (13 % vs. 38 %, p < 0.01). Only one complication (aspiration pneumonia) occurred in the 20 W group.

This study suggests that SVCI using vHPSD appears effective, offering potential advantages in reducing procedure time and improving efficiency.