Conventional-Power Conventional-Duration versus High-Power Short-Duration Radiofrequency Ablation in Same Lesion Size Index-Guided Pulmonary Vein Isolation.

Background: Pulmonary vein isolation (PVI) is used for treating atrial fibrillation, and high-power, short-duration (HP-SD) radiofrequency ablation is considered effective. The depth of myocardial scar in HP-SD ablation is shallower than that in conventional-power, conventionalduration (CP-CD) ablation, and this can be a possible limitation. Hence, the current study aimed to investigate the differences between CP-CD and HP-SD ablation. Methods: Retrospective analyses were performed on patients who received PVI at Fujigaoka Hospital between May 2018 and June 2020. All electroanatomic mapping was performed using EnSite-PrecisionTM cardiac mapping system (Abbott). In both methods, PVI was performed under the same lesion size index (LSI) guidance. The pulmonary veins (PVs) on both sides were divided into six segments (anterior, posterior, roof, bottom, and anterior and posterior parts of the carina). The characteristics of patients and procedures, remnant conduction and early reconnections of the PV after the initial PVI, and clinical outcomes were compared between the CP-CD and HP-SD groups. Results: 200 consecutive patients who underwent same lesion size index-guided PVI were enrolled. The first half of consecutive patients (n = 100) underwent CP-CD ablation, and the second half (n = 100) underwent HP-SD ablation. The CP-CD group had a significantly longer procedure time than the HP-SD group. The remnant conduction and early reconnections in the right anterior carina were significantly less common in the CP-CD group than in the HP-SD group. The 2-year cumulative recurrence rate of all types of atrial fibrillation was comparable between the CP-CD and HP-SD groups. Conclusions: CP-CD and HP-SD radiofrequency ablation had distinct features. Combined CP-CD and HP-SD based on the PV segment, particularly the right PV anterior carina, might be a reasonable approach. [ABSTRACT FROM AUTHOR]