Sergio Castrejón-Castrejón, Marcel Martínez Cossiani, Nuria Basterra Sola, Javier David Romero Roldán, José Luis Ibáñez Criado, Joaquín Osca, Ivo Roca-Luque, Angel Moya, Aurelio Quesada, Víctor Manuel Hidalgo Olivares, Nicasio Pérez Castellano, Juan Manuel Fernández-Gómez, Rosa Macías-Ruiz, Bruno Bochard Villanueva, Nerea Gonzalo Bada, Consuelo Froilán Torres, Beatriz Sanz Verdejo, Paula Sánchez Somonte, Carlos Escobar Cervantes, Raúl Moreno, José Luis Merino
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引用次数: 0
Abstract
Background: The optimal radiofrequency application (RFa) parameters for safe and durable pulmonary vein isolation (PVI) are debated. High-power short-duration (HPSD) has been used as an alternative to conventional power delivery (CPD).
Objectives: This study sought to compare HPSD 70 W/9-10 s (HPSD-70) with CPD 25-40 W in patients undergoing PVI.
Methods: Patients were randomized to HPSD-70 or CPD (25-40). The primary outcomes were freedom from atrial arrhythmia recurrences and the incidence of esophageal thermal lesions (EDELs) after ablation.
Results: Among 304 patients randomized, 301 remained in the study (median age: 61 years; Q1-Q3: 53-69 years; 72% men): 294 patients (97.7%) underwent ablation, 285 (94.7%) underwent endoscopy, and 290 (98.6%) completed the follow-up. At 12 months, 100 patients (73.5%) in the CPD (25-40) group and 87 patients (67%) in the HPSD-70 group were free from recurrences off antiarrhythmic drugs (HR: 1.28; 95% CI: 0.82-1.99; P = 0.28). The incidences of EDELs were 2.7% in the CPD (25-40) group and 3.6% in the HPSD-70 group (P = 0.94). Median left atrial dwell (153 vs 137 min; P = 0.03) and total RF times for definitive PVI (31 vs 11.2 min; P < 0.001) were shorter with HPSD-70 ablation. Four symptomatic embolic events (2 strokes, 1 transient ischemic attack, and 1 splenic infarct) occurred with HPSD-70 and none with CPD (25-40) RFa (P = 0.056).
Conclusions: HPSD-70 RFa was noninferior to prevent arrhythmia recurrences, and the incidence of EDELs was similar compared with CPD (25-40) RFa. The embolic events were numerically higher in the HPSD-70 group. (High Radiofrequency Power for Faster and Safer Pulmonary Vein Ablation Trial [POWER FAST III]; NCT04153747).
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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