Evaluation Of Safety And Efficacy Of High-power Short-duration Radiofrequency Ablation Guided By Ablation Index In Paroxysmal Atrial Fibrillation

Objective: This study aimed to investigate the safety and efficacy of radiofrequency ablation（RFCA）with high power short duration（HPSD）guided by ablation index in patients with paroxysmal atrial fibrillation.Methods: Ninety-five patients with paroxysmal atrial fibrillation who underwent radiofrequency catheter ablation in the Department of Cardiology of the second Hospital of Lanzhou University from September 2020 to July 2021 were enrolled.They were divided into high power short duration group（n = 46）and low power long duration（LPLD）group（n=49）.All operations were guided by Carto threedimensional mapping system and ablated by the VisTag module and ablation index（AI）.Contact force（CF）-sensing catheters and the power-controlled mode was used in both groups and irrigation at 17 to 25ml/min.In the HPSD and LPLD groups,the ablation power was set 45 W or 50 W and 35 W or 40 W,respectively,recommended CF range 5 to 20 g.The AI target values were the exact（450 anterior and ridge,400 roof and inferior,360 to 380 posterior）.All the patients in this study were ablated for the first time.The main operation was circumferential pulmonary vein isolation,and the ablation endpoint was complete electrical isolation of bilateral pulmonary veins.The operator decides whether to perform other extrapulmonary vein-ablation strategies,such as linear ablation and fragmentation potential ablation of the adjacent vestibular region.The total operation time,ablation time,pulmonary vein isolation time,pulmonary vein isolation rate,complications,and follow-up results were compared between the two groups.Results: There was no significant difference in baseline data between the two groups in this study.（1）The success rate of pulmonary vein isolation was 100% in both groups,and the rate of first-pass pulmonary vein isolation in the two groups was similar（85.9% vs.81.6%）.The maintenance rate of sinus rhythm in HPSD and LPLD groups was 86.1% vs.82.9% at the median follow-up ten months,respectively.Moreover,the difference was not statistically significant.（2）The total operation time and ablation time in the HPSD group were significantly shorter than those in the LPLD group（134±8.71 min vs.146.45±12.40 min,1343±231.49 s vs.1508.96±266.92s;P<0.05s）.（3）There were no severe complications between the two groups,and there was no significant difference in the incidence of common complications between the two groups（0% vs.2.1% P>0.05）.（4）The average AI value of the posterior wall and anterior wall in the high power group was significantly higher than that in the low power group（432.59±15.97 vs.411.94±27.99,369.41±10.37 vs.360.33±25.04,P<0.05）.HPSD group was more likely to reach the target value of AI than the LPLD group.Conclusion: High-power short-duration radiofrequency ablation guided by ablation index is a safe,effective,and efficient ablation strategy in paroxysmal atrial fibrillation.