Virtual Conference
Cardiology conference

Sergio Conti

Arnas Civico Hospital, Italy

Title: High-power short-duration lesion index-guided posterior wall isolation on top of pulmonary vein isolation for persistent atrial fibrillation


High-power short-duration (HPSD) radiofrequency (RF) ablation has improved lesion durability in the treatment of atrial fibrillation (AF). However, few data evaluated the impact of HPSD when approaching extra-pulmonary veins (PVs) targets. We aimed to assess the safety, effectiveness, and acute outcomes of HPSD lesion index (LSI)-guided posterior wall isolation (PWI) on top of pulmonary vein isolation (PVI) as an initial treatment approach in persistent atrial fibrillation (Pe-AF). Thirty-five consecutive patients with Pe-AF who underwent HPSD ablation LSI-guided for PWI on top of PVI in our Centre between August 2021 and January 2022 were retrospectively enrolled. RF was set to 50W with target LSI values at ?5 for the anterior PVs aspect and roofline and ?4 for the posterior PVs aspect, bottom line, and within the posterior wall (PW). We compared the LSI values with and without acute conduction gaps after the initial first-pass PWI. Left atrial mapping was performed with the EnSite X mapping system and the multipolar Grid-shaped mapping catheter. We compared procedural characteristics using HPSD (n=35) vs. a control group (n=46). PWI on top of PVI was achieved in all cases in the HPSD group. First-pass PVI was achieved in 93.3% of PVs (n=126/135). First-pass roofline block was obtained in most patients (n=31, 88.5%), while first-pass block of the bottom line was only achieved in 51.4% of patients (n=18). There were no significant differences compared to the control group: first-pass PVI was achieved in 94.9% of PVs (n=169/178), first-pass roofline block in 89.1%, and bottom-line in 45.6% of patients. To achieve complete PWI with HPSD, scattered RF applications within the PW were necessary. No electrical reconnection of the PW was found after adenosine administration. Procedure and RF time were significantly shorter in the HPSD group compared to the control group, 116.2 ± 10.9 vs. 144.5 ± 11.3 minutes, and 22.8 ± 3.6 vs. 42.3 ± 6.4 minutes, respectively, p < 0.001. Fluoroscopy time was comparable between both groups. No procedural complications were observed. HPSD LSI–guided PWI on top of PVI seems effective and safe. Compared to a control group, HPSD is associated with similar rates of first-pass PWI and PVI but with shorter procedural and RF time.


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