Pulmonary Vein Isolation Durability After Very High-power Short-duration Ablation Utilizing a Very-close Protocol - The FAST AND FURIOUS Redo Study

Overview

Journal Int J Cardiol Heart Vasc

Date 2024 Feb 29

PMID 38419611

Authors

Christian-H Heeger

Behnam Subin

Charlotte Eitel

Sorin Stefan Popescu

Huong-Lan Phan

Roman Mamaev

Lorenzo Bartoli

Niels Grosse

Samuel Reincke

Anna Traub

Delgado Lopez

Bettina Kirstein

Sascha Hatahet

Karl-Heinz Kuck

Julia Vogler

Roland R Tilz

Affiliations

Soon will be listed here.

Abstract

Background: Very high-power short-duration (vHP-SD) radiofrequency (RF) ablation of atrial fibrillation (AF) treatment by pulmonary vein isolation (PVI) aims for safer, more effective and faster procedures. Although acute efficacy and safety for PVI was recently shown data on chronic PVI durability is limited. Here chronic PVI durability was evaluated during repeat electrophysiological procedures in patients after initial vHP-SD and conventional RF based PVI.

Methods: A total of 25 consecutive patients with repeat left atrial procedures after initial vHP-SD based PVI were included in this study. Twenty-five patients with previous conventional RF based PVI and repeat left atrial procedures served as control (control group).

Results: For index procedures the median RF time was 328 (277, 392) seconds (vHP-SD) and 1470 (1310, 1742) seconds (control); p < 0.001, the median procedure time was 55 (53, 68) minutes (vHP-SD) and 110 (94, 119) (control); p < 0.001). First pass isolation rate was 84 % (vHP-SD) and 88 % (control, p = 0.888). No differences for severe adverse events (vHP-SD: 1/25, 4 % vs. control: 0/25, 0 %; p = 0.676 were detected.Chronic durability of all PVs was assessed in vHP-SD: 16/25 (64 %) and control: 8/25 (32 %) patients (p = 0.023) and vHP-SD: 81 % and control: 62 % of PVs were found to be isolated (p = 0.003). For right PVs vHP-SD: 84 % vs. control: 60 % of PVs (p < 0.001) and for left PVs vHP-SD: 78 % vs. control: 64 % (p = 0.123) were found to be isolated.

Conclusions: PVI solely utilizing vHP-SD via a very close-protocol provides fast, safe and effective acute PVI. High rates of chronically isolated pulmonary veins have been detected.

Citing Articles

Recent highlights from the : Comprehensive management of atrial fibrillation.

Linz D, Dobrev D Int J Cardiol Heart Vasc. 2024; 53:101478.

PMID: 39175655 PMC: 11339049. DOI: 10.1016/j.ijcha.2024.101478.

Long-term outcome of high-power ablation guided by ablation index in the treatment of atrial fibrillation.

Mao S, Wang L, Fan H, Yang L, Wang X, Liang B J Arrhythm. 2024; 40(3):455-462.

PMID: 38939788 PMC: 11199812. DOI: 10.1002/joa3.13035.

Editorial to: Where is the gap after a 90 W/4 s very high-power short-duration ablation of atrial fibrillation?: Association with the left atrial-pulmonary vein voltage and wall thickness.

Heeger C, Kuck K, Tilz R J Arrhythm. 2024; 40(3):406-407.

PMID: 38939767 PMC: 11199804. DOI: 10.1002/joa3.13019.

Initial experience, safety, and feasibility using remote access or onsite technical support for complex ablation procedures: results of the REMOTE study.

Heeger C, Vogler J, Eitel C, Feher M, Popescu S, Kirstein B Eur Heart J Digit Health. 2024; 5(3):356-362.

PMID: 38774365 PMC: 11104456. DOI: 10.1093/ehjdh/ztae013.

Where is the gap after a 90 W/4 s very-high-power short-duration ablation of atrial fibrillation?: Association with the left atrial-pulmonary vein voltage and wall thickness.

Hirata M, Nagashima K, Watanabe R, Wakamatsu Y, Hirata S, Kurokawa S J Arrhythm. 2024; 40(2):256-266.

PMID: 38586851 PMC: 10995583. DOI: 10.1002/joa3.13009.

References

Magni F, Scherr D, Manninger M, Sohns C, Sommer P, Hovakimyan T . Correction: Electrophysiological findings during re-do procedures after single-shot pulmonary vein isolation for atrial fibrillation with pulsed field ablation. J Interv Card Electrophysiol. 2023; 66(7):1739. PMC: 10547649. DOI: 10.1007/s10840-023-01610-z. View

Bourier F, Duchateau J, Vlachos K, Lam A, Martin C, Takigawa M . High-power short-duration versus standard radiofrequency ablation: Insights on lesion metrics. J Cardiovasc Electrophysiol. 2018; 29(11):1570-1575. DOI: 10.1111/jce.13724. View

Kottmaier M, Popa M, Bourier F, Reents T, Cifuentes J, Semmler V . Safety and outcome of very high-power short-duration ablation using 70 W for pulmonary vein isolation in patients with paroxysmal atrial fibrillation. Europace. 2019; 22(3):388-393. DOI: 10.1093/europace/euz342. View

Munkler P, Kroger S, Liosis S, Abdin A, Lyan E, Eitel C . Ablation Index for Catheter Ablation of Atrial Fibrillation　- Clinical Applicability and Comparison With Force-Time Integral. Circ J. 2018; 82(11):2722-2727. DOI: 10.1253/circj.CJ-18-0361. View

Sciacca V, Fink T, Korperich H, Bergau L, Guckel D, Nischik F . Magnetic resonance assessment of left atrial scar formation following a novel very high-power short-duration workflow for atrial fibrillation ablation. Europace. 2023; 25(4):1392-1399. PMC: 10105851. DOI: 10.1093/europace/euac284. View

Hussein A, Das M, Riva S, Morgan M, Ronayne C, Sahni A . Use of Ablation Index-Guided Ablation Results in High Rates of Durable Pulmonary Vein Isolation and Freedom From Arrhythmia in Persistent Atrial Fibrillation Patients: The PRAISE Study Results. Circ Arrhythm Electrophysiol. 2018; 11(9):e006576. DOI: 10.1161/CIRCEP.118.006576. View

Heeger C, Popescu S, Saraei R, Kirstein B, Hatahet S, Samara O . Individualized or fixed approach to pulmonary vein isolation utilizing the fourth-generation cryoballoon in patients with paroxysmal atrial fibrillation: the randomized INDI-FREEZE trial. Europace. 2021; 24(6):921-927. PMC: 9282912. DOI: 10.1093/europace/euab305. View

Schillaci V, Strisciuglio T, Stabile G, Salito A, Arestia A, Agresta A . Cavotricuspid isthmus ablation by means of very high power, short-duration, temperature-controlled lesions. J Interv Card Electrophysiol. 2022; 65(1):97-102. DOI: 10.1007/s10840-022-01197-x. View

Heeger C, Rexha E, Maack S, Rottner L, Fink T, Mathew S . Reconduction After Second-Generation Cryoballoon-Based Pulmonary Vein Isolation　- Impact of Different Ablation Strategies. Circ J. 2020; 84(6):902-910. DOI: 10.1253/circj.CJ-19-1144. View

10.

Heeger C, Pott A, Sohns C, Riesinger L, Sommer P, Gasperetti A . Novel cryoballoon ablation system for pulmonary vein isolation: multicenter assessment of efficacy and safety-ANTARCTICA study. Europace. 2022; 24(12):1917-1925. PMC: 9733956. DOI: 10.1093/europace/euac148. View

11.

Chun K, Stich M, Furnkranz A, Bordignon S, Perrotta L, Dugo D . Individualized cryoballoon energy pulmonary vein isolation guided by real-time pulmonary vein recordings, the randomized ICE-T trial. Heart Rhythm. 2016; 14(4):495-500. DOI: 10.1016/j.hrthm.2016.12.014. View

12.

Hussein A, Das M, Chaturvedi V, Asfour I, Daryanani N, Morgan M . Prospective use of Ablation Index targets improves clinical outcomes following ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2017; 28(9):1037-1047. DOI: 10.1111/jce.13281. View

13.

Tilz R, Sano M, Vogler J, Fink T, Saraei R, Sciacca V . Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study. Int J Cardiol Heart Vasc. 2021; 35:100847. PMC: 8333145. DOI: 10.1016/j.ijcha.2021.100847. View

14.

Reddy V, Anic A, Koruth J, Petru J, Funasako M, Minami K . Pulsed Field Ablation in Patients With Persistent Atrial Fibrillation. J Am Coll Cardiol. 2020; 76(9):1068-1080. DOI: 10.1016/j.jacc.2020.07.007. View

15.

Hindricks G, Potpara T, Dagres N, Arbelo E, Bax J, Blomstrom-Lundqvist C . 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the.... Eur Heart J. 2020; 42(5):373-498. DOI: 10.1093/eurheartj/ehaa612. View

16.

ONeill L, El Haddad M, Berte B, Kobza R, Hilfiker G, Scherr D . 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. View

17.

Reddy V, Grimaldi M, De Potter T, Vijgen J, Bulava A, Duytschaever M . Pulmonary Vein Isolation With Very High Power, Short Duration, Temperature-Controlled Lesions: The QDOT-FAST Trial. JACC Clin Electrophysiol. 2019; 5(7):778-786. DOI: 10.1016/j.jacep.2019.04.009. View

18.

Osorio J, Hussein A, Delaughter M, Monir G, Natale A, Dukkipati S . Very High-Power Short-Duration, Temperature-Controlled Radiofrequency Ablation in Paroxysmal Atrial Fibrillation: The Prospective Multicenter Q-FFICIENCY Trial. JACC Clin Electrophysiol. 2023; 9(4):468-480. DOI: 10.1016/j.jacep.2022.10.019. View

19.

Kuck K, Brugada J, Furnkranz A, Metzner A, Ouyang F, Chun K . Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016; 374(23):2235-45. DOI: 10.1056/NEJMoa1602014. View

20.

Heeger C, Wissner E, Mathew S, Deiss S, Lemes C, Rillig A . Once Isolated, Always Isolated? Incidence and Characteristics of Pulmonary Vein Reconduction After Second-Generation Cryoballoon-Based Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol. 2015; 8(5):1088-94. DOI: 10.1161/CIRCEP.115.003007. View