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