Initial Results of Routine Use of Atrial Fibrillation Ablation with High Power Short Duration Technique

Introduction: Different results are described after atrial fibrillation (AF) ablation and multiples predictors of recurrence are well established. Objective: Evaluate and analyze the benefits of first atrial fibrillation (AF) ablation with high-power short-duration (HPSD).

Methods: Observational, retrospective study, 212 patients submitted to High Power Short Duration AF ablation (HPSD). Ablation in left atrial posterior wall was performed with 45W with contact force of 3 to 10 grams during 4 to 6 seconds, in the anterior wall we used 50W with contact force of 5 to 20 grams during 4 to 6 seconds and a pump flow of 35ml/min. Males were 155 (73.11%), mean age 61.73 years, paroxysmal AF in 132 (62.26%), 126 (59.43%) hypertension, 96 (45.28%) obstructive apnea, 65(30.66%) arterial disease, 41(19.34%) Diabetes, and 16(7.55%) strokes. Mean time from AF diagnosis to ablation was 20.43 months CHADS2VASC2 2.51.

Results: Mean left atrial time was 72.83 minutes, mean total procedure time 94.79 minutes, mean radiofrequency time of 1,723.8 seconds, 76 (35.85%) of esophageal temperature elevation, mean Xray time of 7.58 minutes, bilateral first-pass isolation effect in 168 (79.25%) patients and mean follow-up was 22.12 (4 to 36) months and recurrence rate after blanking period occurred in 33 (15.57%) patients. Complications were local hematomas in 62 (29.25%) patients, 2 (0.94%) femoral artery pseudoaneurysm, 2 (0.94%) pericardial effusions and 1 (0.47%) cardiac tamponade occurred after transeptal puncture.

Conclution: HPSD showed a high rate of sinus rhythm during the follow-up. Also, we demonstrated a low rate of esophageal heating, a high rate of first-pass isolation effect and short left atrial, total ablation and radiofrequency times with HPSD technique.

Keywords: atrial fibrillation, esophageal temperature, recurrence rate, first-pass isolation, and atrial fibrillation ablation.