Effectiveness and safety of high-power and short-duration ablation for cavotricuspid isthmus ablation in atrial flutter.

Background: Despite many studies on new tools and strategies for cavotricuspid isthmus (CTI) ablation, there is an unmet need to improve the CTI ablation procedure. Recently, high-power short-duration (HPSD) ablation has been widely used for pulmonary vein (PV) isolation in atrial fibrillation. We evaluated the effectiveness and safety of HPSD for CTI ablation in atrial flutter (AFL).

Methods: Eighty-four patients who underwent CTI ablation with or without simultaneous PV isolation between January 2018 and February 2019 were enrolled in this prospective cohort study. We compared procedural characteristics, periprocedural complications, and recurrence of atrial tachyarrhythmia (ATa) between the HPSD group (50 W for 15 s) and conventional group (30 W for 60 s).

Results: A total of 84 patients were divided into the HPSD (n = 42) and conventional (n = 42) groups. Bidirectional CTI block was achieved in all patients and 95% achieved bidirectional block after the first-line ablation in both groups. Although there was no difference in the total number of ablation lines between the two groups (1.17 ± 0.7 vs 1.38 ± 0.8, P = .067), HPSD ablation significantly reduced total ablation time compared to the conventional group (236.0 ± 85.6 vs 534.2 ± 235.2 s, P < .001). One pericardial tamponade was reported in the HPSD group. During the mean follow-up of 9.3 ± 4.8 months, CTI-dependent AFL recurrence occurred in one patient in the HPSD group. Recurrence of ATa developed in 14 patients with no significant difference between the groups.

Conclusion: Our study demonstrates that HPSD CTI ablation is safe and can shorten procedure time.