Co-Author(s):
Akash Mavilakandy, MBchB
Ibrahim Antoun, MD
Zakariyya Vali, MBchB
Xin Li, PhD
Tiago Paggi De Almeida, PhD
Andre Ng, MBChb, PhD
University of Leicester
Department of Cardiovascular Sciences University of Leicester Clinical Sciences Wing Glenfield Hospital Leicester, LE3 9QP
Introduction | Objectives: Pulmonary vein isolation (PVI) for treatment of Atrial fibrillation (AF) using radiofrequency (RF) catheter technology has advanced over the last 10 years with very high power short duration (vHPSD) ablation (90W, 4s) being a new mode of therapy delivery. Having been the first UK centre to adopt this, we hereby report on the procedural data of this early experience compared with standard RF in a contemporary cohort.
Methods: Patients having first time PVI performed under i.v. sedation with vHPSD using QMode+ (n=15, Qdot, Biosense Webster) were compared with those having standard Ablation Index guided RF ablation (n=15, Thermocool ST/SF, Biosense Webster). Demographics, clinical and procedural data were collected.
Results: Total Ablation time (11 ± 2 vs. 44 ± 4 min, p < 0.0001) and total procedure duration (152 ± 7 vs. 196 ± 14 min, P = 0.02) were significantly shorter in the vHPSD group compared to standard RF whereas fluoroscopy time was similar (Figure 1). Doses of i.v. sedation (midazolam) used was significantly lower in vHPSD than standard RF (3.2 ± 0.8 vs. 11.1 ± 1.5mg, p = 0.004) as was those of i.v. analgesia (morphine) (11.7 ± 0.9 vs. 15.5 ± 1.2mg, P = 0.024). When using Qmode+ 6.6 ± 1.4 additional carina lesions were required compared to 4.8 ± 1.2 for standard RF (P = 0.338). No adverse procedural events were recorded for the vHPSD group while two small non- haemodynamically significant pericardial effusions occurred in the standard RF group, which were conservatively managed.
Conclusions: PVI completed with vHPSD RF ablation (90W, 4s) in paroxysmal AF patients reduced total ablation time and procedure duration with good safety profile. The use of sedation and analgesics was significantly reduced compared with standard RF ablation thus conferring an advantage for procedures to be completed efficiently without general anaesthesia which is particular relevant in resource allocation under concurrent COVID circumstances.
AFS 2021-53