Feasibility of Hybriding Very High-Power Short-Duration and Ablation Index-Guided Pulmonary Vein Isolation

A novel temperature-controlled radiofrequency (RF) catheter enables pulmonary vein isolation (PVI) using very high-power short-duration (vHPSD) ablation, reducing esophageal injury risk but raising concerns about lesion durability in thicker atrial myocardium. This study aimed to assess the efficacy and safety of a hybrid approach that integrates conventional Ablation Index (AI)-guided PVI with vHPSD ablation.

This prospective, single-center study enrolled 160 consecutive patients with atrial fibrillation (AF) between January 2023 and December 2023, who were allocated into two groups. Group 1 (n = 80) underwent conventional AI-guided PVI using a 40 W setting, while Group 2 (n = 80) received a hybrid approach combining 90 and 50 W ablation with a temperature-controlled RF catheter (QDOT Micro, Biosense Webster Inc., Diamond Bar, CA).

Group 2 demonstrated a significantly shorter duration for PVI compared to Group 1 (28 ± 11 min vs. 35 ± 10 min, p < 0.001), with similar rates of first pass isolation (86% vs. 89%, p = 0.63) and acute reconnection (10% vs. 5%, p = 0.23). Complication rates were comparable between the groups (1.3% vs. 1.3%, p = 1.00), with no cases of esophageal or phrenic nerve injury reported. Kaplan-Meier analysis showed no significant difference in freedom from AF at 1 year (84% vs. 83%, log-rank p = 0.78).

The integration of Ablation Index-guided ablation with vHPSD ablation, utilizing a novel temperature-controlled RF catheter, significantly reduces procedural duration while maintaining safety and efficacy comparable to conventional AI-guided PVI.