Abstract 16274: Endurance Ablation With Moderately Increased Radiofrequency Power Facilitates Long-lasting Circumferential Pulmonary Vein Isolation And Better Clinical Outcomes In Patients With Paroxysmal Atrial Fibrillation
Introduction: Recurrence of paroxysmal atrial fibrillation (PAF) after radiofrequency catheter ablation (RFCA) is related to the reconnection of circumferential pulmonary vein isolation (CPVI).
Hypothesis: We hypothesized that endurance ablation with moderately increased radiofrequency (RF) power would facilitate long-lasting CPVI and better clinical outcomes in patients with PAF.
Methods: We included 508 PAF patients (76.0% male, 56.2±9.5 years old) who underwent CPVI without additional left atrial (LA) ablation. We compared endurance ablation (ENDU-abl; n=254, 30 sec ablation at each point with 35W on anterior PV antrum and 25~30W on posterior LA) group with an age-, sex-, and follow up duration-matched conventional ablation (CONV-abl; n=254, just elimination of PV potential [PVP] with 25W) group.
Results: 1. Total procedure time (p<0.001) and ablation time (p<0.001) were longer, and complication rate was higher (6.3% vs. 1.6%, p=0.006) in ENDU-abl group than in CONV-abl group. 2. HF domain (p=0.010) and LF/HF ratio (<0.001) were significantly lower at 3rd month follow-up heart rate variability, and the degree of LA reverse remodeling was more significant at 1-year follow-up echocardiogram (ΔLAVI; -6.0±8.3 vs. -3.5±9.5 mL/m2, p=0.031) in ENDU-abl group than in CONV-abl group. 3. During 37.2±17.5 months of follow-up, the clinical recurrence of AF was significantly lower in ENDU-abl group than in CONV-abl group (log-rank, p<0.001). 4. Among 38 patients who underwent redo-ablation at 15.1±12.1 months, reconnected PVPs were found in 4/11 patients (36.4%) in ENDU-abl group and 26/27 patients (96.3%) in the CONV-abl group (p<0.001).
Conclusions: In spite of longer procedure time and higher complication risk, ENDU-abl with moderately increased RF power facilitated long-lasting CPVI, more significant autonomic neural remodeling and LA reverse remodeling, and better clinical outcome than CONV-abl in PAF patients.
Author Disclosures: H. Yu: None. J. Park: None. T. Kim: None. J. Uhm: None. J. Kim: None. B. Joung: None. M. Lee: None. H. Pak: None.
- © 2016 by American Heart Association, Inc.