Optimized workflow with hybrid (very) high-power short-duration radiofrequency ablation renders point-by-point pulmonary vein isolation as fast and effective as cryoballoon ablation

被引：0
作者：
Fusaroli, Marco [1 ,2 ]
Hoogendijk, Mark G. [1 ]
Bhagwandien, Rohit E. [1 ]
Wijchers, Sip A. [1 ]
van Boven, Nick [1 ,3 ]
Mahmoodi, Bakthawar K. [1 ]
Yap, Sing-Chien [1 ]
机构：
[1] Erasmus MC, Cardiovasc Inst, Thorax Ctr, Dept Cardiol, Rotterdam, Netherlands
[2] Univ Florence, Careggi Univ Hosp, Sch Human Hlth Sci, Dept Expt & Clin Med, Florence, Italy
[3] Franciscus Gasthuis & Vlietland, Dept Cardiol, Rotterdam, Netherlands
来源：
JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY | 2025年
关键词：
Atrial fibrillation; Cryoballoon ablation; High power short duration; Very high power short duration; Atrial arrhythmia recurrence;
D O I：
10.1007/s10840-025-01982-4
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Introduction A hybrid approach with very high-power short-duration (vHPSD) posteriorly and ablation-index guided HPSD (50 W) anteriorly seems to be an optimal balance between efficiency and effectiveness for point-by-point pulmonary vein isolation (PVI). The aim of the current study is to compare vHPSD/HPSD ablation to cryoballoon ablation (CBA) in patients with symptomatic atrial fibrillation (AF). Methods and results In this retrospective single-center study, we identified 110 consecutive patients who underwent their first PVI with either vHPSD/HPSD (n = 54) or CBA (n = 56). We compared procedural efficacy, efficiency, safety, and long-term outcomes. Baseline characteristics of both groups were comparable; however, patients in the vHPSD/HPSD group had larger left atrial volume index (35, IQR 27-45 vs. 28, IQR 21-36 ml/m(2), P = 0.005). Complete PVI was achieved in all patients except two CBA cases (100% vs. 96.4%, P = 0.50). First-pass isolation rate was 79.6% in the hybrid group. Procedure times were similar between groups (53, IQR 47-63 vs. 55, IQR 49-65 min, P = 0.35), but fluoroscopy time was shorter in the vHPSD/HPSD group (3.9 [2.7, 5.6] vs. 11.9 [9.3, 14.9] min, P < 0.001). There were 3 temporary phrenic nerve palsies (5.4%) in the CBA group which resolved within 1 year. The 1-year freedom from any atrial tachyarrhythmias after a single procedure was similar between groups (68.5% vs. 73.2%, P = 0.56). During repeat procedure, the durability of PVI was comparable. Conclusions The use of vHPSD/HPSD ablation renders point-by-point PVI as fast and effective as CBA. Furthermore, it has lower radiation exposure compared to CBA.
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页数：10
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  • [1] van Gelder I.C., Rienstra M., Bunting K.V., Casado-Arroyo R., Caso V., Crijns H., de Potter T.J.R., Dwight J., Guasti L., Hanke T., Jaarsma T., Lettino M., Lochen M.L., Lumbers R.T., Maesen B., Molgaard I., Rosano G.M.C., Sanders P., Schnabel R.B., Suwalski P., Svennberg E., Tamargo J., Tica O., Traykov V., Tzeis S., Kotecha D., 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS), Eur Heart J,
  • [2] Reddy V.Y., Gerstenfeld E.P., Natale A., Whang W., Cuoco F.A., Patel C., Mountantonakis S.E., Gibson D.N., Harding J.D., Ellis C.R., Ellenbogen K.A., DeLurgio D.B., Osorio J., Achyutha A.B., Schneider C.W., Mugglin A.S., Albrecht E.M., Stein K.M., Lehmann J.W., Mansour M., Investigators A., Pulsed field or conventional thermal ablation for paroxysmal atrial fibrillation, N Engl J Med, 389, pp. 1660-1671, (2023)
  • [3] Kuck K.H., Furnkranz A., Chun K.R., Metzner A., Ouyang F., Schluter M., Elvan A., Lim H.W., Kueffer F.J., Arentz T., Albenque J.P., Tondo C., Kuhne M., Sticherling C., Brugada J., Fire and Investigators ICE. Cryoballoon or radiofrequency ablation for symptomatic paroxysmal atrial fibrillation: Reintervention, rehospitalization, and quality-of-life outcomes in the FIRE AND ICE trial, Eur Heart J, 37, pp. 2858-2865, (2016)
  • [4] Kuck K.H., Brugada J., Furnkranz A., Metzner A., Ouyang F., Chun K.R., Elvan A., Arentz T., Bestehorn K., Pocock S.J., Albenque J.P., Tondo C., Fire and Investigators ICE. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation, N Engl J Med, 374, pp. 2235-2245, (2016)
  • [5] Lee A.C., Voskoboinik A., Cheung C.C., Yogi S., Tseng Z.H., Moss J.D., Dewland T.A., Lee B.K., Lee R.J., Hsia H.H., Marcus G.M., Vedantham V., Chieng D., Kistler P.M., Dillon W., Vittinghoff E., Gerstenfeld E.P., A randomized trial of high vs standard power radiofrequency ablation for pulmonary vein isolation: SHORT-AF, JACC Clin Electrophysiol, 9, pp. 1038-1047, (2023)
  • [6] Ravi V., Poudyal A., Abid Q.U., Larsen T., Krishnan K., Sharma P.S., Trohman R.G., Huang H.D., High-power short duration vs. conventional radiofrequency ablation of atrial fibrillation: a systematic review and meta-analysis, Europace, 23, pp. 710-721, (2021)
  • [7] Kottmaier M., Popa M., Bourier F., Reents T., Cifuentes J., Semmler V., Telishevska M., Otgonbayar U., Koch-Buttner K., Lennerz C., Bartkowiak M., Kornmayer M., Rousseva E., Brkic A., Grebmer C., Kolb C., Hessling G., Deisenhofer I., Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation, Europace, 22, pp. 388-393, (2020)
  • [8] Chen S., Schmidt B., Bordignon S., Urbanek L., Tohoku S., Bologna F., Angelkov L., Garvanski I., Tsianakas N., Konstantinou A., Trolese L., Weise F., Perrotta L., Chun K.R.J., Ablation index-guided 50 W ablation for pulmonary vein isolation in patients with atrial fibrillation: Procedural data, lesion analysis, and initial results from the FAFA AI High Power Study, J Cardiovasc Electrophysiol, 30, pp. 2724-2731, (2019)
  • [9] Prospective randomized evaluation of high power during CLOSE-guided pulmonary vein isolation: The POWER-AF study, Circ Arrhythm Electrophysiol, 14, (2021)
  • [10] Reddy V.Y., Grimaldi M., De Potter T., Vijgen J.M., Bulava A., Duytschaever M.F., Martinek M., Natale A., Knecht S., Neuzil P., Purerfellner H., Pulmonary vein isolation with very high power, short duration, temperature-controlled lesions: the QDOT-FAST trial, JACC Clin Electrophysiol, 5, pp. 778-786, (2019)
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