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SHR Neuro Cancer Cardio Lipid Metab Microb

O'Neill, L; El, Haddad, M; Berte, B; Kobza, R; Hilfiker, G; Scherr, D; Manninger, M; Wijnmaalen, AP; Trines, SA; Wielandts, JY; Gillis, K; Lycke, M; De, Becker, B; Tavernier, R; Le, Polain, De, Waroux, JB; Knecht, S; Duytschaever, M.
Very High-Power Ablation for Contiguous Pulmonary Vein Isolation: Results From the Randomized POWER PLUS Trial.
JACC Clin Electrophysiol. 2023; 9(4):511-522 Doi: 10.1016/j.jacep.2022.10.039
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Co-authors Med Uni Graz

Manninger-Wünscher Martin

Scherr Daniel

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Abstract:

BACKGROUND: Very high-power, short-duration (90-W/4-second) ablation for pulmonary vein isolation (PVI) may reduce procedural times. However, shorter applications with higher power may impact lesion quality. OBJECTIVES: In this multicenter, randomized controlled trial, the authors compared procedural efficiency, efficacy, and safety of PVI using 90-W/4-second ablation to 35/50-W ablation. METHODS: Patients with paroxysmal or persistent atrial fibrillation undergoing first-time PVI were randomized to pulmonary vein encirclement with contiguous applications using very high-power, short-duration applications (90 W over 4 seconds) or 35/50-W applications (titrated up to ablation index >550 anteriorly and >400 posteriorly). Prospective endpoints were procedural efficiency (procedure time and first-pass isolation), safety (including esophageal endoscopic evaluation), and 6-month effectiveness using repetitive Holter monitoring. RESULTS: A total of 180 patients were randomized, 90 to the 90-W group (mean age: 64.2 ± 8.9 years) and 90 to the 35/50-W group (mean age: 62.3 ± 10.8 years). Procedural time was shorter in the 90-W group vs the 35/50-W group (70 [IQR: 60-80] minutes vs 75 [IQR: 65-88.3] minutes; P = 0.009). A nonsignificant trend towards lower rates of first-pass isolation was seen in the 90-W group (83.9% vs 90%; P = 0.0852). No major complications were observed in both groups with esophageal injury occurring in 1 patient per group. At 6 months, 17% of patients in the 90-W group vs 15% in the 35/50-W group experienced recurrent arrhythmia (P = 0.681). CONCLUSIONS: Contiguous ablation using very high-power, short-duration applications results in a significant but modest reduction in procedure time with similar safety and 6-month efficacy vs a conventional approach. A hybrid approach combining both ablation modalities might be the most optimal strategy. (POWER PLUS [Very High Power Ablation in Patients With Atrial Fibrillation Schedule for a First Pulmonary Vein Isolation]; NCT04784013).

Find related publications in this database (using NLM MeSH Indexing)

Humans - administration & dosage

Middle Aged - administration & dosage

Aged - administration & dosage

Pulmonary Veins - surgery

Prospective Studies - administration & dosage

Treatment Outcome - administration & dosage

Atrial Fibrillation - surgery

Esophagus - injuries

Catheter Ablation - adverse effects, methods

Find related publications in this database (Keywords)

atrial fibrillation

efficacy

high-power ablation

safety

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