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Long-term Outcomes After Low Power, Slower Movement versus High Power, Faster Movement Irrigated-Tip Catheter Ablation for Atrial Fibrillation.
Long-term Outcomes After Low Power, Slower Movement versus High Power, Faster Movement Irrigated-Tip Catheter Ablation for Atrial Fibrillation. Heart rhythm Bunch, T. J., May, H. T., Bair, T. L., Crandall, B. G., Cutler, M. J., Mallender, C., Weiss, J. P., Osborn, J. S., Day, J. D. 2019Abstract
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