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Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: short-term results of the POWER-FAST PILOT study

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Abstract

Purpose

Pulmonary vein (PV) isolation (PVI) by point-by-point radiofrequency application (PPRF) results in longer procedures than that achieved by single-shot ablation techniques. In addition, it is associated with significant risk of oesophageal injury. The POWER-FAST pilot study evaluated the feasibility and safety of PVI by high-power short-duration (HPSD) PPRF.

Methods

HPSD PPRF around the PVs was done in 48 consecutive patients with atrial fibrillation. Fifty watts was delivered until a predefined lesion index value was reached (LSI ≥ 5 or Abl-I ≥ 350) and 60 W during 7–10 s in the first 18 and last 30 patients, respectively. A control group of 47 consecutive patients who had undergone PVI before the HPSD group with conventional PPRF (30 W for 30 s) was included for reference. Echocardiography and oesophageal endoscopy was performed shortly after ablation in all patients.

Results

PVI of all targeted veins was achieved in 98% and 100% of patients of the conventional and HPSD groups, respectively (p = 0.59). Total radiofrequency time was 34 ± 11, 24 ± 8, and 15 ± 5 min in groups 30 W, 50 W, and 60 W (p < 0.001). Audible steam pops occurred in 4 out of 48 (8%) patients in the HPSD group, accounting for 4 (0.08%) out of 5 269 HPSD radiofrequency applications. No patient in the HPSD group developed pericardial effusion. The incidence of oesophageal lesions was 28%, 22%, and 0% in groups 30 W, 50 W, and 60 W, respectively (p = 0.007)

Conclusions

PVI can be achieved with HPSD PPRF in most patients. This approach appears safe and associated with low risk of esophageal damage.

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Funding

This work was funded in part by a research grant from the Spanish Society of Cardiology (Dr. Pedro Zarzo Clinical Research Project 2014 and Bayer Clinical Research Project 2018) and the Instituto de Salud Carlos III (Clinical Research Project PI18/01522, 2018).

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Authors and Affiliations

  1. Arrhythmia and Robotic Electrophysiology Unit, Cardiology Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain

    Sergio Castrejón-Castrejón, Marcel Martínez Cossiani, Marta Ortega Molina, Carlos Escobar, José Luis López Sendón & José Luis Merino

  2. Gastroenterology Acute Unit, Gastroenterology Department, Hospital Universitario La Paz, Madrid, Spain

    Consuelo Froilán Torres, Nerea Gonzalo Bada, Marta Díaz de la Torre & José Manuel Suárez Parga

Authors
  1. Sergio Castrejón-Castrejón
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  2. Marcel Martínez Cossiani
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  3. Marta Ortega Molina
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  4. Carlos Escobar
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  5. Consuelo Froilán Torres
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  6. Nerea Gonzalo Bada
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  7. Marta Díaz de la Torre
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  8. José Manuel Suárez Parga
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  9. José Luis López Sendón
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  10. José Luis Merino
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Corresponding author

Correspondence to José Luis Merino.

Ethics declarations

This study was approved by the ethics committee of La Paz University Hospital – Hospital La Paz Institute for Health Research (PI-3271, 2018). Written informed consent was obtained from all patients.

Conflict of interest

JL Merino reports personal fees from Abbott, Bayer, Biotronik, Boston Scientific, Cardiome, Daiichi Sankyo, Medtronic, Microport, and Sanofi outside the submitted work.

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Castrejón-Castrejón, S., Martínez Cossiani, M., Ortega Molina, M. et al. Feasibility and safety of pulmonary vein isolation by high-power short-duration radiofrequency application: short-term results of the POWER-FAST PILOT study. J Interv Card Electrophysiol 57, 57–65 (2020). https://doi.org/10.1007/s10840-019-00645-5

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  • DOI: https://doi.org/10.1007/s10840-019-00645-5

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