Long-term outcome of lesion size index-guided high-power ablation with high-density mapping for pulmonary vein isolation in patients with paroxysmal atrial fibrillation.

INTRODUCTION

Data on the long-term outcomes and procedural details of the lesion size index-guided high-power ablation strategy (HP-LSI) are limited.

METHODS

Eighty patients were retrospectively assigned to the high-power with time-restricted ablation strategy (fixed at 10 s per lesion), while 67 patients were assigned to the high power LSI-guided strategy (anterior wall LSI at least 5.0, posterior wall LSI 4.5). The 1-year AF recurrence rate and various procedural details were compared between the two groups.

RESULTS

The HP-LSI group exhibited a significantly lower rate of AF recurrence (14.9% vs. 32.5%; HR: 0.36, 95% CI: 0.16-0.83;  = 0.016). Additionally, fewer gaps were identified in various PV segments in the HP-LSI group following the initial pass of PV circumferential ablation. The radiofrequency time, LA dwelling time, and skin-to-skin time were shorter, and the first-pass isolation rates for both pulmonary veins were higher in the HP-LSI group.

CONCLUSION

The HP-LSI ablation strategy is associated with a significantly lower AF recurrence rate and improved procedural efficiency, suggesting its potential as a preferred strategy for PVI.