Abstract

BACKGROUND: High power, shorter duration (HPSD) ablation strategies have been advocated to increase efficacy and minimize posterior wall deep tissue thermal injury during atrial fibrillation (AF) ablation.OBJECTIVE: Determine the long-term outcomes of arrhythmia free-survival from AF and atrial flutter (AFL) between HPSD and low power, longer duration (LPLD) ablation strategies.METHODS: Of a total of 1,333 first time AF ablation with 3 years of follow up, propensity-matched populations for baseline risk factors were created comprising of 402 patients treated with low power LPLD (30 W for 5 seconds: posterior wall, 30 W for 10-20 seconds: anterior wall) and 402 patients treated with HPSD (50 W for 2-3 seconds: posterior wall and 50 W for 5-15 seconds: anterior wall). AF/AFL outcomes after a 90-day blacking period were assessed.RESULTS: HPSD ablation was associated with shorter procedures and fluoroscopy times (p<0.0001 for both). Recurrence of AF at 1 (12.9% vs 16.2%, p=0.19) and 3 years (26.5% vs 30.7%, p=0.23) was similar between LPLD and HPSD, respectively. AFL was higher at 1 (7.2% vs 11.2%, p=0.03) and 3 years (16.1% vs 21.8%, p=0.06, p=0.04 after multivariate adjustment) with HPSD ablation. Patients with a LPLD approach had lower rates of need for a repeat ablation (21% vs 30%, p=0.002).CONCLUSIONS: Long-term freedom from AF rates were not significantly different between both approaches. A HPSD ablation strategy compared to a LPLD approach was associated with an increased risk of AFL and need for repeat ablation, but lowered procedure times.

View details for DOI 10.1016/j.hrthm.2019.08.001

View details for PubMedID 31398477