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Atrial fibrillation ablation workflow optimization facilitated by high-power short-duration ablation and high-resolution mapping

Europace, ISSN: 1532-2092, Vol: 26, Issue: 3
2024
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    Mentions
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    Social Media
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High-power short-duration ablation protocol “reduces procedure times”

©whyframeshot – stock.adobe.com High-power short-duration ablation results in significantly shorter procedure times without affecting procedural efficacy and safety among patients undergoing ablation for atrial fibrillation

Article Description

Aims Pulmonary vein isolation (PVI) for catheter ablation of atrial fibrillation (AF) is a time-demanding procedure. High-power short-duration (HPSD) ablation protocols and high-density mapping catheters have recently been introduced to clinical practice. We investigated the impact of high-density mapping and HPSD ablation protocols on procedural timing, efficacy, and safety by comparing different standardized set-ups. Methods Three electrophysiology (EP) laboratory set-ups were analysed: (i) circular catheter for mapping and HPSD ablation with 30/and results 35 W guided by an ablation index (AI); (ii) pentaspline catheter for mapping an HPSD ablation with 50 W guided by an AI; and (iii) pentaspline catheter for mapping and HPSD ablation with 90 W over 4 s using a novel ablation catheter. All patients underwent PVI without additional left atrial ablation strategies. Procedural data and operating intervals in the EP laboratory were systematically analysed. Three hundred seven patients were analysed (30/35 W AI: n = 102, 50 W AI: n = 102, 90 W/4 s: n = 103). Skin-to-skin times [105.3 ± 22.7 (30/35 W AI) vs. 81.4 ± 21.3 (50 W AI) vs. 69.5 ± 12.2 (90 W/4 s) min, P ≤ 0.001] and total laboratory times (132.8 ± 42.1 vs. 107.4 ± 25.7 vs. 95.2 ± 14.0 min, P < 0.001) significantly differed among the study groups. Laboratory interval analysis revealed significant shortening of mapping and ablation times. Arrhythmia-free survival after 12 months was not different among the study groups (log-rank P = 0.96). Conclusion The integration of high-density mapping and HPSD protocols into an institutional AF ablation process resulted in reduced procedure times without compromising safety or efficacy.

Bibliographic Details

Fink, Thomas; Sciacca, Vanessa; Nischik, Flemming; Bergau, Leonard; Guckel, Denise; El Hamriti, Mustapha; Khalaph, Moneeb; Braun, Martin; Winnik, Stephan; Didenko, Maxim; Imnadze, Guram; Sommer, Philipp; Sohns, Christian

Oxford University Press (OUP)

Medicine

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