| ObjectiveThe purpose of this study was to evaluate the difference in effectiveness,safety and characteristics of high-power,short-duration(HPSD)radiofrequency catheter ablation(RFA)guided by a relatively low ablation index(AI)and conventional RFA in atrial fibrillation(AF)patients,and to analyze the risk factors and arrhythmia characteristics for recurrence.MethodsRadiofrequency ablation was performed on isolated porcine hearts and lesion size was recorded at AI values of 300,400,and 500,respectively.In this single-center prospective cohort study,we investigated 1283 AF patients who underwent first RFA at Guangdong Provincial People’s Hospital from July 2019 to March 2021,comparing 787 patients in the HPSD group with 496 patients in the conventional group,and subgroup analysis was performed according to AF type.The HPSD RFA strategy(40-50 W;AI 350-400 in the anterior,350-420 in the superior and inferior,320-380 in the posterior wall)was compared with the conventional RFA strategy(25-35 W for posterior wall,35-40 W at other sites,without AI guidance)in AF patients.The main procedure in patients with paroxysmal AF(PAF)was pulmonary vein isolation(PVI).While in persistent AF(PeAF)patients,PVI plus linear ablation was mainly performed.Whether ablated non-pulmonary vein(PV)triggers and/or other sites was at the operators’ discretion.The success rate and safety of the two groups were compared,and the characteristics of recurrent arrhythmia during reoperation were analyzed.Propensity-score matching analyses were used to compare the outcomes of PAF patients between the two groups.A multivariable Cox proportional hazards regression analysis was used to investigate any predictors associated with one-year AF recurrence.ResultsIn our animal study,and the damage depths were positively correlated with the AI values.The depths of 3.5±0.2mm,4.0±0.3mm,and 4.3±0.2mm were obtained for AI values of 300,400,and 500,respectively.In 943 patients with PAF(547 in the HPSD group and 396 in the conventional group),the early recurrence rate was higher in the HPSD group than in the conventional group after using propensity score matching analysis(22.73%vs 13.64%,P=0.003),while following a single ablation procedure,the late recurrence rate was similar in both groups(19.81%vs 15.58%,P=0.17).There was no significant difference for early recurrent atrial arrhythmia types between the two groups(P=0.17),with 54.29%and 52.38%of recurrences of AF in the HPSD and conventional groups respectively.The proportion of late recurrences of regular atrial tachycardia was significantly higher in the HPSD group compared with the conventional group(65.57%vs 41.67%,P=0.01).In patients who underwent repeat RF ablation,there was no significant difference between the two groups in the proportion of chronic pulmonary vein reconnection(PVR)(P=0.48)and non-PV triggers(P=0.32).The site of chronic PVR in both groups was mostly found in the right PV and left carina.For the 240 patients with PeAF in the HPSD group,the early recurrence rate was 38.75%and the late recurrence rate was 33.33%after a single procedure,with 66.67%and 53.75%of early and late recurrences of AF respectively.The touch-up ablation sites during the repeat procedure were most commonly in the left superior PVs,the roof of left atrium(LA),cavotricuspid isthmus and mitral isthmus.In the multivariate Cox regression analysis,LA size was an independent risk factor for recurrence of late atrial arrhythmias in both PAF and PeAF.In terms of safety,the complication rates were similar in both groups(p=0.99).The HPSD ablation strategy was safe and feasible with no increased risk of esophageal injury or other complications.ConclusionsAI can better predict the depth of lesions.Under the guidance of relatively low AI values,HPSD RFA strategy appeared to be feasible,effective and safe for AF patients.And LA size was an independent risk factor for late atrial arrhythmia recurrence. |
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