Pulmonary vein isolation for atrial fibrillation using true high-power short-duration vs. cryoballoon ablation

• Published in: Clinical research in cardiology Vol. 112; no. 6; pp. 846 - 852
• Main Authors: Wörmann, Jonas, Lüker, Jakob, van den Bruck, Jan-Hendrik, Filipovic, Karlo, Erlhöfer, Susanne, Scheurlen, Cornelia, Dittrich, Sebastian, Schipper, Jan-Hendrik, Steven, Daniel, Sultan, Arian
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2023; Springer Nature B.V
• Subjects: Ablation; Arrhythmia; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Cardiac arrhythmia; Cardiology; Catheter Ablation - methods; Catheters; Complications; Cryosurgery; Dwell time; EKG; Electronic equipment; Humans; Interrogation; Medical instruments; Medicine; Medicine & Public Health; Original Paper; Prospective Studies; Pulmonary Veins - surgery; Radio frequency; Recurrence; Survival; Survival analysis; Treatment Outcome; Veins; High power short duration; Cryoballoon ablation; Atrial fibrillation ablation; Pulmonary vein isolation
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-023-02188-2

Aims Pulmonary vein isolation (PVI) is achievable and effective using radiofrequency (RF) catheter (CA) or cryoballoon (CB) ablation. The newly introduced high RF-power short-duration ablation (HPSD) technique has shown promising results. Data comparing HPSD- to CB-PVI is sparse. We sought to investigate success rates and procedural differences of HPSD-PVI vs. CB-PVI in patients undergoing ablation for PAF and persAF. Methods Consecutive patients undergoing de novo PVI (HPSD or CB) were included. A power setting of 70W/7 s (70W/5 s at posterior wall) using a flexible tip catheter with enhanced irrigation was considered as true HPSD. Follow-up consisted of out-clinic pts visits, tele-consultation, 48-h Holter ECG, app-based telemonitoring and cardiac implanted electronic devices (CIED) interrogation. Results 721 patients (46 HPSD, 675 CB) were analyzed. In all HPSD (27 persAF [59%]) and CB patients (423 persAF [63%]), PVI was successfully achieved. Procedure duration was significantly longer for HPSD (91 ± 19 min vs. 72 ± 18 min, p  < 0.01). Ablation time was similar in both groups (HPSD: 44 ± 19 min vs. CB: 40 ± 17 min; p  = 0.347). No major complications occurred in HPSD. For CB-PVI, in 25 (3.7%; p  = 0.296) patients, complications occurred. At a follow-up of 290 ± 135 days, arrhythmia-free survival using HPSD was non-inferior to CB-PVI in the Kaplan–Meier survival analysis ( p  = 0.096). Conclusion PVI using HPSD is equally effective and safe to CB-PVI. This analysis revealed a similar arrhythmia-free survival after HPSD and CB with low complication rates. Procedure duration for CB was significantly shorter while LA dwell time excluding mapping was equal. Currently, a prospective trial is conducted to corroborate these findings.