High-power short-duration versus low-power long-duration ablation guided by the ablation index

Autor: Pedro A, Sousa, Luís, Puga, Sérgio, Barra, Luís, Adão, João, Primo, Ziad, Khoueiry, Ana, Lebreiro, Paulo, Fonseca, Mariana, Pereira, Philippe, Lagrange, Andre, d'Avila, Bárbara, Oliveiros, Luís, Elvas, Lino, Gonçalves
Rok vydání: 2023
Předmět:
Zdroj: International Journal of Cardiology. 370:209-214
ISSN: 0167-5273
DOI: 10.1016/j.ijcard.2022.10.013
Popis: To compare the two different ablation strategies, both guided by the Ablation Index (AI), in the setting of atrial fibrillation (AF) ablation: high-power short-duration (HPSD) ablation using 40 W on the posterior wall and 50 W elsewhere versus low-power long-duration (LPLD) using 25 W posteriorly and 35 W elsewhere.Prospective, multicenter nonrandomized, noninferiority study of consecutive patients referred for paroxysmal AF ablation from January 2018 to July 2019. Ablation was guided by the AI (≥500 for anterior segments, ≥450 for the roof and inferior segments and 400 posteriorly) and an interlesion distance (ILD) ≤ 6 mm. Patients were separated into two groups: HPSD vs LPLD. Acute reconnection (after adenosine trial) and 2-year outcomes were assessed.160 patients (61% males, median age of 62 [IQR 51-69] years), fulfilled the study inclusion criteria - 80 patients (316 pulmonary veins [PV]) in the HPSD group and 80 patients (314 PV) in the LPLD. The probability of acute PV reconnection was similar between both groups: 2.2% in HPSD, 95%CI 0.6% to 3.8% vs. 3.4% in LPLD, 95%CI 1.4% to 5.4%; p 0.001 for noninferiority. Median PV ablation time (20 min vs 30 min, p 0.01) and procedure duration (80 min vs 100 min, p 0.001) were shorter in the HPSD group. After a median follow-up of 26 months, arrhythmia recurrence was similar between groups (17.5% in HPSD group vs. 18.8% in LPLD group, p = 0.79).In paroxysmal AF patients treated with the Ablation Index, a HPSD strategy is noninferior to the more standard LPLD ablation, while allowing for quicker procedures with shorter ablation times.
Databáze: OpenAIRE
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