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Background: When using lesion size index (LSI) to guide catheter ablation, it is unclear what combination of power, contact force and time would be preferable to use and what LSI target value to aim for. This study aimed at identifying desirable ablation settings and LSI targets by using tissue impedance drop as indicator of lesion formation. Methods: Consecutive patients, undergoing their first left atrial (LA) catheter ablation for atrial fibrillation, with radiofrequency energy (RF) powers of 20, 30 and 40 W were enrolled. Tissue impedance, contact force (CF), Force Time Integral (FTI) and LSI values were continuously recorded during ablation and sampled at 100 Hz. Mean CF and Contact Force Variability (CFV) were calculated for every lesion. The effect of RF power, ablation time, CF and CFV on impedance drop and LSI were assessed. Results: A total of 3258 lesions were included in the analysis. For any target LSI value, use of higher RF powers translated into progressively higher impedance drops. The impact of lower CF and higher CFV on impedance drop was more relevant when using lower powers. Target LSI values corresponding to maximum impedance drop were identified depending on RF power, mean CF and CFV used. Conclusions: Even in the context of an LSI‐guided ablation strategy, use of lower or higher powers might lead to different lesion sizes. Different LSI targets might be needed depending on the combination of RF power, CF and CFV used for ablation. Incorporating indicators of catheter stability, like CFV, in the LSI formula could improve the predictive value of LSI for lesion size. Studies with clinical outcomes are required to confirm the clinical relevance of these findings. [ABSTRACT FROM AUTHOR]

Background and Aims Patterns of atrial fibrillation (AF) recurrence post-catheter ablation for persistent AF (PsAF) are not well described. This study aimed to describe the pattern of AF recurrence seen following catheter ablation for PsAF and the implications for healthcare utilization and quality of life (QoL). Methods This was a post-hoc analysis of the CAPLA study, an international, multicentre study that randomized patients with symptomatic PsAF to pulmonary vein isolation plus posterior wall isolation or pulmonary vein isolation alone. Patients underwent twice daily single lead ECG, implantable device monitoring or three monthly Holter monitoring. Results 154 of 333 (46.2%) patients (median age 67.3 years, 28% female) experienced AF recurrence at 12-month follow-up. Recurrence was paroxysmal in 97 (63%) patients and persistent in 57 (37%). Recurrence type did not differ between randomization groups (P =.508). Median AF burden was 27.4% in PsAF recurrence and.9% in paroxysmal AF (PAF) recurrence (P <.001). Patients with PsAF recurrence had lower baseline left ventricular ejection fraction (PsAF 50% vs. PAF 60%, P <.001) and larger left atrial volume (PsAF 54.2 ± 19.3 mL/m² vs. PAF 44.8 ± 11.6 mL/m², P =.008). Healthcare utilization was significantly higher in PsAF (45 patients [78.9%]) vs. PAF recurrence (45 patients [46.4%], P <.001) and lowest in those without recurrence (17 patients [9.5%], P <.001). Patients without AF recurrence had greater improvements in QoL as assessed by the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire (Δ33.3 ± 25.2 points) compared to those with PAF (Δ24.0 ± 25.0 points, P =.012) or PsAF (Δ13.4 ± 22.9 points, P <.001) recurrence. Conclusions AF recurrence is more often paroxysmal after catheter ablation for PsAF irrespective of ablation strategy. Recurrent PsAF was associated with higher AF burden, increased healthcare utilization and antiarrhythmic drug use. The type of AF recurrence and AF burden may be considered important endpoints in clinical trials investigating ablation of PsAF. [ABSTRACT FROM AUTHOR]

Background: Temperature-controlled high-power short-duration (HPSD) radiofrequency catheter ablation for pulmonary vein isolation (PVI) utilizing a novel ablation catheter (QDOT Micro) with real-time assessment of catheter tip temperature aims for safer, more effective and faster procedures., Methods: The peQasus study is a large European multicenter study set up to assess safety, acute efficacy and outcomes of temperature-controlled HPSD based PVI. The primary endpoints were safety, efficacy and 12-months freedom from atrial tachyarrhythmias. Additionally, two strategies namely very HPSD (90W for 4 seconds) only and a hybrid approach (HPSD with maximum of 50W and vHPSD) were compared., Results: A total of 1,023 AF patients in 15 centers from 9 European countries received PVI with the QDOT. Complete PVI was successfully achieved in all patients. In 699/1023 (68.3%) the vHPSD only approach (vHPSD group) and in 324/(31.7%) patients the hybrid approach (hybrid group) was utilized. The mean procedure duration was 98.4±37.4 min (vHPSD: 88.2±34.9min, hybrid: 117.4±32.7min, p<0.001). The first pass isolation rate of all PVs was 64% (vHPSD: 62.6%, hybrid: 67.1%, p=0.187). Severe adverse events were observed in 1.7% (vHPSD: 1.6%, hybrid: 1.9%, p=0.746). 12-month arrhythmia-recurrence free survival was 77.1% (vHPSD: 76.8%, hybrid: 77.8%, p=0.241)., Conclusions: In this large multicentre study temperature-controlled HPSD and vHPSD ablation via a novel ablation catheter provides safe and effective PVI with a relatively short procedure duration. Despite a shorter procedure time no differences in terms of safety and freedom from arrhythmia-recurrence were found irrespective of utilizing vHPSD or the hybrid approach., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: Atrial fibrillation (AF) is more common in patients with hypertrophic cardiomyopathy (HCM) and is often highly symptomatic. The impact of catheter ablation (CA) may be under-reported when evaluated by long-term freedom from any atrial arrhythmia., Objectives: This study aims to evaluate whether CA of AF in patients with HCM would significantly reduce AF burden and improve symptoms., Methods: A multicenter registry was established to enroll HCM patients with pre-existing cardiac implantable electronic devices undergoing CA of AF between 2017 and 2021. The first AF recurrence and burden 12 months before and after CA were determined., Results: Eighty-one HCM patients with cardiac implantable electronic devices underwent CA of AF. Patients were followed-up for a minimum of 1-year (35 [Q1-Q3 range: 23-50] months). AF was paroxysmal in 38 of 81 (46.9%) patients and burden pre-CA was 27.0% (Q1-Q3 range: 3.0% to 99.0%). Thirty-five (43.2%) patients had AF/atrial tachycardia recurrence within 12 months. AF burden reduced after CA to 0.5% (Q1-Q3 range: 0.0% to 11.1%) (P = 0.001); a 95% CI (range: 13.8% to 100%) relative reduction. European Hearth Rhythm Association class improved by 1.8 ± 1.3 classes (P < 0.001). Of those with AF/atrial tachycardia recurrence, the reduction in AF burden was -33.7% (Q1-Q3 range: -88.9% to -13.8%) (P < 0.001) and 20 (57.1%) patients reported symptomatic improvement by ≥1 European Hearth Rhythm Association class. AF burden reduction was associated with symptomatic improvement. (r = -0.67; P < 0.001) CONCLUSIONS: AF recurrence is common after CA in HCM patients, but this may under-represent the impact of CA in this cohort. CA significantly reduced AF burden and improved symptoms. A comprehensive evaluation of AF burden, symptoms, and hard endpoints is needed to determine the utility of CA in this context., Competing Interests: Funding Support and Author Disclosures Dr Boveda has received consulting fees from Medtronic, Boston Scientific, Microport, and Zoll. Dr Rinaldi has received research funding and consulting fees from Abbott, Medtronic, Boston Scientific, Microport, and Siemens/EBR systems. Dr Ginks has received speaker fees and travel grants from Biosense Webster, Atricure, and Abbott. Dr Lambiase has received research grants from Medtronic, Abbott, and Boston Scientific; and his work has been supported by UCLH Biomedicine NIHR and Barts BRC. Dr Hunter has received research grants and educational grants from Medtronic and Biosense Webster; and has received speaker fees and travel grants from Medtronic, Biosense Webster, and Abbott. Drs Honarbakhsh and Hunter invented the STAR mapping system and are shareholders in Rhythm AI Ltd. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Aims: Catheter ablation for atrial fibrillation (AF) has historically required inpatient admission post-procedure, but same-day discharge (SDD) has recently been reported. We aimed to assess the efficacy and safety of SDD compared with overnight stay (OS) post-ablation., Methods and Results: We performed a systematic search of the PubMed database. Random-effects meta-analysis was performed to assess the efficacy (successful SDD) and safety (24 h complications, 30-day complications, 30-day re-admissions, and 30-day mortality) of a SDD AF ablation strategy. Fourteen non-randomized observational studies met criteria for inclusion, encompassing 26488 patients undergoing AF ablation, of whom 9766 were SDD. The mean age of participants was 61.9 years, and 67.9% were male. Around 61.7% underwent ablation for paroxysmal AF. The pooled success rate of SDD was 83.2% [95% confidence intervals (CIs): 61.5-97.0%, I2 100%]. The risk of bias was severe for all effect estimates due to confounding, as most cohorts were retrospectively identified without appropriately matched comparators. There was no significant difference in 30-day complications [odds ratio (OR): 0.95, 95% CI: 0.65-1.40, I2 53%] or 30-day re-admission (OR 0.96, 95% CI: 0.49-1.89, I2 82%) between groups. There were insufficient data for meta-analysis of 24 h complications and 30-day mortality. Where reported, no re-admissions occurred due to 24 h complications after SDD. Two deaths (0.04%) were reported in both SDD and OS groups., Conclusion: Same-day discharge after AF ablation appears to be an effective and safe strategy in selected patients. However, the available evidence is of low quality, and more robust prospective studies comparing SDD to OS are needed., Competing Interests: Conflict of interest: R.S.W. has received honoraria and/or travel assistance from Biosense Webster, Bayer, Boston Scientific, Merit Medical, and Abbott. M.R.G. has received honoraria from Biosense Webster and Abbott., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)