Acute and long-term efficacy of ablation index-guided higher power shorter duration ablation in patients with atrial fibrillation: A prospective registry.

Background: Theoretically, targeting the same ablation index (AI) using higher power may achieve the same lesion size with a shorter ablation time. We evaluated the acute and long-term efficacy of higher-powered ablation guided by ablation index (HPAI) compared with conventional-powered ablation guided by AI (CPAI) for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF).

Methods: Drug refractory symptomatic AF patients who had been ablated with 40 W on the anterior/roof segments and 30 W on the posterior/inferior/carina segments were enrolled (HPAI group). We compared the HPAI group with the CPAI group who were ablated with 30 W on the anterior/roof segments and 25 W on the posterior/inferior/carina segments. The same AI was targeted (≥450 on the anterior/roof segments and ≥350 on the posterior/inferior/carina segments). We compared ablation time, acute pulmonary vein reconnection (PVR) and 1-year AF recurrence between the two groups.

Results: A total of 118 patients were included (86 in the HPAI group and 32 in the CPAI group, paroxysmal AF, 73%). There was no significant difference in the acute PVR rate between the HPAI and the CPAI groups (3.7% vs. 4.2%,  = .580) with a 41% reduction in ablation time for PVI (38.7 ± 8.3 vs. 65.8 ± 13.7 minutes,  < .001). The 1-year AF recurrence rate was not significantly different between HPAI and CPAI groups (12.8% vs. 21.9%, Log-rank  = .242). There were no major complications in either group.

Conclusions: Increased power during AF ablation, using the same AI targets, reduced the procedure and ablation times, and showed a comparable acute and long-term outcome without compromising safety.

Clinical Trial Registration: https://www.clinicaltrials.gov. Unique identifier: NCT04379557.