Prospective Multicenter Registry to Investigate the Clinical Feasibility of Combination Workflow With 90 W/4 s and Ablation Index-Guided 50 W Ablation (PRECISE—COMBO 90 W/50 W Study)

IF 1.7 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Yuji Saito, Ryuta Watanabe, Koichi Nagashima, Yuji Wakamatsu, Shu Hirata, Moyuru Hirata, Masaomi Kimura, Junjiroh Koyama, Hideharu Okamatsu, Yuki Komatsu, Kenichi Hiroshima, Kaoru Tanno, Takahiro Furuya, Naoki Aizawa, Yuichiro Sakamoto, Taishi Kuwahara, Toshio Makita, Kenta Takahashi, Shiro Nakahara, Hirotsugu Sato, Hideyuki Aoki, Masahide Harada, Yuji Motoike, Jin Teranishi, Shin Takahara, Kenta Murotani, Yasuo Okumura
{"title":"Prospective Multicenter Registry to Investigate the Clinical Feasibility of Combination Workflow With 90 W/4 s and Ablation Index-Guided 50 W Ablation (PRECISE—COMBO 90 W/50 W Study)","authors":"Yuji Saito,&nbsp;Ryuta Watanabe,&nbsp;Koichi Nagashima,&nbsp;Yuji Wakamatsu,&nbsp;Shu Hirata,&nbsp;Moyuru Hirata,&nbsp;Masaomi Kimura,&nbsp;Junjiroh Koyama,&nbsp;Hideharu Okamatsu,&nbsp;Yuki Komatsu,&nbsp;Kenichi Hiroshima,&nbsp;Kaoru Tanno,&nbsp;Takahiro Furuya,&nbsp;Naoki Aizawa,&nbsp;Yuichiro Sakamoto,&nbsp;Taishi Kuwahara,&nbsp;Toshio Makita,&nbsp;Kenta Takahashi,&nbsp;Shiro Nakahara,&nbsp;Hirotsugu Sato,&nbsp;Hideyuki Aoki,&nbsp;Masahide Harada,&nbsp;Yuji Motoike,&nbsp;Jin Teranishi,&nbsp;Shin Takahara,&nbsp;Kenta Murotani,&nbsp;Yasuo Okumura","doi":"10.1002/joa3.70199","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>High-power short-duration (HPSD) ablation is an established therapy for pulmonary vein (PV) isolation (PVI) in atrial fibrillation (AF), aiming to form efficient transmural lesions. Very HPSD (vHPSD) can further shorten ablation time but may increase the risk of acute PVI failure compared with HPSD. A combined HPSD and vHPSD strategy (90 W/50 W combination workflow) potentially balances efficiency and durability, though its clinical feasibility remains unknown. Therefore, this multicenter registry evaluated the acute and long-term efficacy of a 90 W/50 W combination workflow for PVI in patients with paroxysmal AF.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In this prospective study, a total of 101 consecutive patients with paroxysmal AF underwent PVI using radiofrequency ablation with a 90 W/50 W combination workflow. We evaluated acute outcomes, including first-pass isolation and acute PV reconnection, and monitored atrial tachyarrhythmia recurrences over 12 months.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Median PVI procedure time was 35 min, with total procedure time at 105 min. First-pass PVI was achieved in 58.4% of patients, including 74.3% in the right PV and 72.3% in the left PV. Acute PV reconnection occurred in 31.7% (32/101). In multivariate analysis, carina sites independently predicted acute PVI failure in both HPSD and vHPSD groups, while contact force also predicted failure in the HPSD group. After 1 year, 89.9% of patients remained free from documented atrial tachyarrhythmias.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>The 90 W/50 W combination workflow did not notably shorten procedure time or enhance first-pass success. More standardized strategies, particularly in carina segments with higher contact force and ablation index under HPSD, may be required to ensure optimal lesion durability and favorable outcomes.</p>\n </section>\n </div>","PeriodicalId":15174,"journal":{"name":"Journal of Arrhythmia","volume":"41 5","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/joa3.70199","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Arrhythmia","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/joa3.70199","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0

Abstract

Background

High-power short-duration (HPSD) ablation is an established therapy for pulmonary vein (PV) isolation (PVI) in atrial fibrillation (AF), aiming to form efficient transmural lesions. Very HPSD (vHPSD) can further shorten ablation time but may increase the risk of acute PVI failure compared with HPSD. A combined HPSD and vHPSD strategy (90 W/50 W combination workflow) potentially balances efficiency and durability, though its clinical feasibility remains unknown. Therefore, this multicenter registry evaluated the acute and long-term efficacy of a 90 W/50 W combination workflow for PVI in patients with paroxysmal AF.

Methods

In this prospective study, a total of 101 consecutive patients with paroxysmal AF underwent PVI using radiofrequency ablation with a 90 W/50 W combination workflow. We evaluated acute outcomes, including first-pass isolation and acute PV reconnection, and monitored atrial tachyarrhythmia recurrences over 12 months.

Results

Median PVI procedure time was 35 min, with total procedure time at 105 min. First-pass PVI was achieved in 58.4% of patients, including 74.3% in the right PV and 72.3% in the left PV. Acute PV reconnection occurred in 31.7% (32/101). In multivariate analysis, carina sites independently predicted acute PVI failure in both HPSD and vHPSD groups, while contact force also predicted failure in the HPSD group. After 1 year, 89.9% of patients remained free from documented atrial tachyarrhythmias.

Conclusion

The 90 W/50 W combination workflow did not notably shorten procedure time or enhance first-pass success. More standardized strategies, particularly in carina segments with higher contact force and ablation index under HPSD, may be required to ensure optimal lesion durability and favorable outcomes.

Abstract Image

前瞻性多中心注册研究90w /4 s和消融指数引导的50w消融联合工作流程的临床可行性(PRECISE-COMBO 90w / 50w研究)
背景:高功率短时间(HPSD)消融是房颤(AF)肺静脉(PV)隔离(PVI)的一种成熟治疗方法,旨在形成有效的跨壁病变。与HPSD相比,vHPSD可进一步缩短消融时间,但可能增加急性PVI衰竭的风险。结合HPSD和vHPSD策略(90w / 50w组合工作流)可能平衡效率和耐用性,但其临床可行性尚不清楚。因此,这项多中心注册研究评估了90w / 50w联合工作流程治疗阵发性房颤患者PVI的急性和长期疗效。方法在这项前瞻性研究中,共有101例连续的阵发性房颤患者采用90w / 50w联合工作流程射频消融进行PVI治疗。我们评估了急性结果,包括首次隔离和急性PV重连,并监测了12个月内的房性心动过速复发。结果中位PVI手术时间为35 min,总手术时间为105 min。首次通过PVI的患者比例为58.4%,其中右侧PV为74.3%,左侧PV为72.3%。急性PV再连接发生率为31.7%(32/101)。在多变量分析中,隆突部位独立预测了HPSD组和vHPSD组的急性PVI衰竭,而接触力也预测了HPSD组的衰竭。1年后,89.9%的患者没有记录在案的房性心动过速。结论90w / 50w组合工作流程没有显著缩短手术时间或提高首次通过成功率。可能需要更标准化的策略,特别是在HPSD下接触力和消融指数较高的隆突节段,以确保最佳的病变耐久性和良好的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Arrhythmia
Journal of Arrhythmia CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.90
自引率
10.00%
发文量
127
审稿时长
45 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信