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

Elena Carrion1, Maria Fuentes1, Ana M Ambrona1

  • 1Electrophysiology Laboratory and Arrhythmia Unit, HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Medical School, Universidad CEU San Pablo, Madrid, Spain.

JACC. Clinical Electrophysiology
|June 23, 2026
PubMed
Summary
This summary is machine-generated.

High-power, short-duration (HPSD) radiofrequency ablation guided by the Lesion Size Index (LSI) algorithm shows greater durability for pulmonary vein (PV) isolation. This method results in fewer redo procedures and lower PV reconnection rates compared to conventional radiofrequency ablation.

Keywords:
atrial fibrillation ablationelectrophysiologypulmonary vein isolationpulmonary vein reconnection patternsreintervention

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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.