Redo Ablation Following LSI Algorithm-Guided High-Power Short-Duration vs LSI Algorithm-Guided Conventional...

Area of Science:

• Electrophysiology
• Cardiac Ablation
• Atrial Fibrillation Treatment

Background:

• Clinical studies have compared conventional radiofrequency (RF) with high-power, short-duration (HPSD) RF for pulmonary vein (PV) isolation.
• Few studies have utilized guiding indices or reported on redo procedures following initial PV isolation.
• The efficacy and durability of different RF delivery methods for PV isolation require further investigation.

Purpose of the Study:

• To analyze redo procedures in patients undergoing their first PV isolation.
• To compare Lesion Size Index (LSI) algorithm-guided RF ablation using HPSD versus conventional RF.
• To evaluate the impact of HPSD (50 W) versus conventional (30 W) RF delivery on PV reconnection and procedural success.

Main Methods:

• Retrospective analysis of 701 consecutive patients who underwent first PV isolation using LSI algorithm-guided RF.
• Patients were divided into two groups: conventional RF (30 W, n=362) and HPSD RF (50 W, n=339).
• Redo procedures were analyzed, and gap sites/epicardial connections were identified using the pace-and-map maneuver.

Main Results:

• Fewer redo procedures were required in the HPSD group (1.5%) compared to the conventional group (5%) within the first year (P = 0.009).
• The HPSD group showed a higher proportion of isolated PVs (32% vs 18%, P = 0.048) and lower right inferior PV reconnection (25% vs 62%, P = 0.021).
• Gaps in the ridge and Marshall epicardial connections were more frequent in the HPSD group (50% vs 22%, P = 0.012), suggesting potential limitations in deeper atrial tissue.

Conclusions:

• LSI algorithm-guided PV isolation using HPSD ablation (50 W) demonstrates superior durability compared to 30 W ablation.
• HPSD ablation is associated with significantly lower rates of redo procedures and PV reconnection.
• The increased reconnection in the ridge/Marshall region with HPSD may indicate a need for optimized lesion depth in thicker atrial tissue.