Abstract
Introduction: Ablation Index guided ablation according to the CLOSE
protocol is very effective in terms of chronic pulmonary vein isolation
(PVI). However, the optimal RF power remains controversial. Here, we
thought to investigate the efficiency and safety of an AI guided fixed
circumferential 50W high power short duration (HPSD) PVI using the CLOSE
protocol
Methods and results: In a single-centre prospective ”proof of concept”
trial 40 patients underwent randomized PVI using AI guided RF ablation
without oesophageal temperature monitoring. In 20 patient fixed 50W HPSD
was used irrespective to the anatomical localization. 20 subjects were
ablated with standard power settings (20W posterior and 40W roof and
anterior wall). Additionally, 80 consecutive patients were treated
according to the HPSD protocol to gather additional safety data. All
patients underwent post-procedural oesophago-gastro-duodenoscopy to
reveal oesophageal lesions (EDEL).
The mean total procedural time was 80.3±22.5 minutes in HPSD compared to
control 109.1±27.4 (p<0.001). The total RF-time was
significantly lower in HPSD 1379±505 sec vs. control 2374±619 sec
(p<0.001).There were no differences in periprocedural
complications. EDEL occurred in 13% in the HPSD and 10% in control
group. EDEL occurring in the 50W HSDP patients were smaller, more
superficial and had a faster healing tendency.
Conclusions: A fixed 50W HPSD circumferential PVI relying to the
ablation index and CLOSE protocol reduces the total procedure time and
the total RF time compared to standard CLOSE protocol, without
increasing the complication rates. The incidence of oesophageal lesions
was similar using 50W at the posterior atrial wall.