Details

Autor(en) / Beteiligte

• Joza, Jacqueline
• Nair, Girish M.
• Birnie, David H.
• Nery, Pablo B.
• Redpath, Calum J.
• Sarrazin, Jean‐Francois
• Champagne, Jean
• Bernick, Jordan
• Wells, George A.
• Essebag, Vidal
• Roux, Jean‐Francois
• Dussault, Charles
• Parkash, Ratika
• Bernier, Martin
• Sterns, Laurence D.
• Sapp, John
• Novak, Paul
• Veenhuyzen, George
• Morillo, Carlos A.
• Singh, Sheldon M.
• Sadek, Mouhannad M.
• Golian, Mehrdad
• Klein, Andres
• Sturmer, Marcio
• Chauhan, Vijay S.
• Angaran, Paul
• Green, Martin S.

Titel

High‐power short‐duration versus low‐power long‐duration ablation for pulmonary vein isolation: A substudy of the AWARE randomized controlled trial

Ist Teil von

• Journal of cardiovascular electrophysiology, 2024-01, Vol.35 (1), p.136-145

Ort / Verlag

United States: Wiley Subscription Services, Inc

Erscheinungsjahr

2024

Quelle

MEDLINE

Beschreibungen/Notizen

• Introduction Pulmonary vein isolations (PVI) are being performed using a high‐power, short‐duration (HPSD) strategy. The purpose of this study was to compare the clinical efficacy and safety outcomes of an HPSD versus low‐power, long‐duration (LPLD) approach to PVI in patients with paroxysmal atrial fibrillation (AF). Methods Patients were grouped according to a HPSD (≥40 W) or LPLD (≤35 W) strategy. The primary endpoint was the 1‐year recurrence of any atrial arrhythmia lasting ≥30 s, detected using three 14‐day ambulatory continuous ECG monitoring. Procedural and safety endpoints were also evaluated. The primary analysis were regression models incorporating propensity scores yielding adjusted relative risk (RRa) and mean difference (MDa) estimates. Results Of the 398 patients included in the AWARE Trial, 173 (43%) underwent HPSD and 225 (57%) LPLD ablation. The distribution of power was 50 W in 75%, 45 W in 20%, and 40 W in 5% in the HPSD group, and 35 W with 25 W on the posterior wall in the LPLD group. The primary outcome was not statistically significant at 30.1% versus 22.2% in HPSD and LPLD groups with RRa 0.77 (95% confidence interval [CI]) 0.55–1.10; p = .165). The secondary outcome of repeat catheter ablation was not statistically significant at 6.9% and 9.8% (RRa 1.59 [95% CI 0.77–3.30]; p = .208) respectively, nor was the incidence of any ECG documented AF during the blanking period: 1.7% versus 8.0% (RRa 3.95 [95% CI 1.00–15.61; p = .049) in the HPSD versus LPLD group respectively. The total procedure time was significantly shorter in the HPSD group (MDa 97.5 min [95% CI 84.8–110.4)]; p < .0001) with no difference in adjudicated serious adverse events. Conclusions An HPSD strategy was associated with significantly shorter procedural times with similar efficacy in terms of clinical arrhythmia recurrence. Importantly, there was no signal for increased harm with a HPSD strategy. In this large substudy of the AWARE Trial, a high‐power short‐duration (HPSD) radiofrequency ablation strategy was found to be similarly effective as a low‐power long‐duration strategy with no difference in time to first recurrence of any AF lasting ≥30 s. Procedural were substantially reduced with HPSD ablation with no significant difference in overall complication rates.