Popa Miruna A, Krafft Hannah, Bahlke Fabian, Englert Florian, Lengauer Sarah, Telishevska Marta, Erhard Nico, Tydecks Madeleine, Hadamitzky Martin, Bourier Felix, Reents Tilko, Klupp Elisabeth, Lennerz Carsten, Hessling Gabriele, Deisenhofer Isabel, Kottmaier Marc
Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Lazarettstraße 36, Munich 80636, Germany.
Munich Arrhythmia Research and Study Center (MARS), Technical University of Munich, Lazarettstraße 36, Munich 80636, Germany.
Europace. 2025 Aug 4;27(8). doi: 10.1093/europace/euaf105.
Very high-power short-duration (vHPSD) was developed to optimize radiofrequency ablation for atrial fibrillation (AF). However, data on vHPSD ≥ 70W remains limited. We investigated acute efficacy, safety and long-term rhythm outcomes of vHPSD-70W in a randomized controlled trial.
A total of n = 200 patients with paroxysmal AF were randomly assigned 1:1 to receive pulmonary vein isolation (PVI) using vHPSD (70 W/5-7 s) or standard (30-40W, 20-40 s) ablation with a flexible, enhanced-irrigation tip catheter. Primary endpoint was the number of reconnected pulmonary veins (rPV) after adenosine testing. Secondary endpoints included first-pass isolation (FPI), silent cerebral lesions (SCLs) and rhythm outcomes on 12-month follow-up. Mean number of rPVs was 0.6 ± 0.8 vs. 0.8 ± 0.9 (P = 0.145) with vHPSD-70W vs. standard ablation. Bilateral FPI was 42.7% vs. 30.2% (P = 0.072), while FPI of left PVs was higher with vHPSD-70W (63.5% vs. 49.0%, P = 0.042). Procedure (107.7 ± 34.2 vs. 131.3 ± 42.2 min) and radiofrequency (15.1 ± 6.7 vs. 41.8 ± 18.3 min) duration were significantly lower with vHPSD-70W (P < 0.001). Silent cerebral lesions occurred in 1/25 (4.0%) vs. 3/22 (13.6%, P = 0.328). On 12-month follow-up, freedom from any atrial arrhythmia (76.0% vs. 66.7%, P = 0.171) was similar, while vHPSD-70W showed a lower incidence of atrial tachycardia (AT) recurrence (1.0% vs. 10.4%, P = 0.005).
Very high-power short-duration with 70 W/5-7 s was non-superior to standard ablation regarding acute PV reconnection and 12-month freedom from any atrial arrhythmia. However, vHPSD-70W achieved a higher FPI rate of left PVs with a shorter procedure duration and a comparable safety profile. AT recurrence was significantly less common with vHPSD-70W.
超高功率短持续时间（vHPSD）技术旨在优化心房颤动（AF）的射频消融治疗。然而，关于≥70W的vHPSD的数据仍然有限。我们在一项随机对照试验中研究了vHPSD - 70W的急性疗效、安全性和长期节律结果。
总共200例阵发性房颤患者被随机1:1分配，使用带有灵活、增强灌注尖端导管的vHPSD（70W/5 - 7秒）或标准（30 - 40W，20 - 40秒）消融进行肺静脉隔离（PVI）。主要终点是腺苷试验后重新连接的肺静脉（rPV）数量。次要终点包括首次通过隔离（FPI）、无症状脑损伤（SCLs）以及12个月随访时的节律结果。vHPSD - 70W组与标准消融组相比，rPV的平均数量分别为0.6±0.8和0.8±0.9（P = 0.145）。双侧FPI分别为42.7%和30.2%（P = 0.072），而vHPSD - 70W组左肺静脉的FPI更高（63.5%对49.0%，P = 0.042）。vHPSD - 70W组的手术时间（107.7±34.2对131.3±42.2分钟）和射频时间（15.1±6.7对41.8±18.3分钟）显著更短（P < 0.001）。无症状脑损伤在1/25（4.0%）与3/22（13.6%）中出现（P = 0.328）。在12个月随访时，无任何房性心律失常的比例相似（76.0%对66.7%，P = 0.171），而vHPSD - 70W组房性心动过速（AT）复发的发生率较低（1.0%对10.4%，P = 0.005）。
就急性肺静脉重新连接和12个月无任何房性心律失常而言，70W/5 - 7秒的超高功率短持续时间并不优于标准消融。然而，vHPSD - 70W实现了更高的左肺静脉FPI率，手术时间更短且安全性相当。vHPSD - 70W组AT复发明显较少见。
