Feasibility of Hybriding Very High‐Power Short‐Duration and Ablation Index‐Guided Pulmonary Vein Isolation

TL;DR

A new hybrid ablation method for treating atrial fibrillation reduces procedure time without compromising safety or effectiveness.

Contribution

A hybrid approach combining Ablation Index-guided and high-power short-duration ablation is shown to reduce procedure duration while maintaining safety.

Findings

The hybrid group had significantly shorter pulmonary vein isolation time (28 ± 11 min vs. 35 ± 10 min).

Complication rates and 1-year arrhythmia-free survival were comparable between the hybrid and conventional groups.

No esophageal or phrenic nerve injuries were reported in either group.

Abstract

A novel temperature‐controlled radiofrequency (RF) catheter enables pulmonary vein isolation (PVI) using very high‐power short‐duration (vHPSD) ablation, reducing esophageal injury risk but raising concerns about lesion durability in thicker atrial myocardium. This study aimed to assess the efficacy and safety of a hybrid approach that integrates conventional Ablation Index (AI)‐guided PVI with vHPSD ablation.

This prospective, single‐center study enrolled 160 consecutive patients with atrial fibrillation (AF) between January 2023 and December 2023, who were allocated into two groups. Group 1 (n = 80) underwent conventional AI‐guided PVI using a 40 W setting, while Group 2 (n = 80) received a hybrid approach combining 90 and 50 W ablation with a temperature‐controlled RF catheter (QDOT Micro, Biosense Webster Inc., Diamond Bar, CA).

Group 2 demonstrated a significantly shorter duration for PVI compared to Group 1 (28 ± 11 min vs. 35 ± 10 min, p < 0.001), with similar rates of first pass isolation (86% vs. 89%, p = 0.63) and acute reconnection (10% vs. 5%, p = 0.23). Complication rates were comparable between the groups (1.3% vs. 1.3%, p = 1.00), with no cases of esophageal or phrenic nerve injury reported. Kaplan–Meier analysis showed no significant difference in freedom from AF at 1 year (84% vs. 83%, log‐rank p = 0.78).

The integration of Ablation Index‐guided ablation with vHPSD ablation, utilizing a novel temperature‐controlled RF catheter, significantly reduces procedural duration while maintaining safety and efficacy comparable to conventional AI‐guided PVI.

Compared to conventional Ablation Index (AI)‐guided ablation, the hybrid AI + very high‐power short‐duration (vHPSD) strategy significantly reduced pulmonary vein isolation time (28 ± 11 vs. 35 ± 10 min, p < 0.001), with comparable first‐pass isolation (86% vs. 89%, p = 0.63), acute reconnection (10% vs. 5%, p = 0.23), complication rates (1.3% vs. 1.3%), and 1‐year arrhythmia‐free survival (84% vs. 83%, log‐rank p = 0.78).

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