Very High‐Power Short‐Duration Ablation for Atrial Fibrillation in Adults With Congenital Heart Disease

TL;DR

A new ablation technique using high power and short duration is safe and effective for treating atrial fibrillation in adults with congenital heart disease.

Contribution

Demonstrates the safety and effectiveness of vHPSD ablation in ACHD patients with paroxysmal or persistent AF.

Findings

No ablation-related complications occurred in ACHD patients using vHPSD ablation.

77.8% of patients with paroxysmal AF were free from atrial arrhythmia after one year.

Persistent AF patients had limited success with 43.6% freedom from arrhythmia after one year.

Abstract

Data regarding safety and long‐term outcome of very high‐power‐short duration (vHPSD) ablation in adult congenital heart disease (ACHD) patients with paroxysmal or persistent atrial fibrillation (AF) are lacking.

Retrospective observational single‐center study. The data of 66 consecutive ACHD patients (mean age 60 ± 12.8 years, 46% male) with mild (69.7%), moderate (22.7%), or complex (7.6%) congenital heart disease (CHD) who underwent ablation for paroxysmal (40.9%) or persistent AF (59.1%) were analyzed. Circumferential PVI was performed in all patients and additional substrate ablation in 79,4% of persistent AF patients using irrigated RF energy with vHPSD settings of 70 W/5–7 s or 60 W/7–10 s.

Mean procedure time was 123.6 ± 42 min with a mean RF time of 18.19 ± 10 min. No technique related adverse events occurred. Vascular access complications were detected in seven patients (10.6%) requiring intervention in four patients (6%). A median follow‐up time of 491 days (IQR: 194–1054 days). Freedom from any atrial arrhythmia off antiarrhythmic drugs (AAD) at 1 year was present in 58% of patients (77.8% with paroxysmal AF, 43.6% with persistent AF).

vHPSD for ablation of paroxysmal or persistent AF in ACHD patients is safe and effective. Regardless of CHD complexity, no vHPSD ablation modality related complications occurred. Long‐term outcome for paroxysmal AF after one ablation was excellent whereas results for persistent AF were limited.

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