Arq. Bras. Cardiol. 2024; 121(12): e20240771
High-power, Short-duration Radiofrequency Ablation of Atrial Fibrillation: Point-by-Point or Catheter Dragging Technique?
This Short Editorial is referred by the Research article "High Power Short Duration Atrial Fibrillation Ablation: Long-Term Predictors of Success and Recurrence – A Multivariate Analysis".
Pulmonary vein isolation (PVI) is universally accepted as the cornerstone of atrial fibrillation (AF) ablation. Current guidelines recommend electrical isolation of the pulmonary veins in all AF ablation procedures (Class I, level of evidence A). As of today, the most common methods to perform PVI are point-by-point radiofrequency (RF) guided by 3D mapping or the cryoballoon. Both are thermal energies, creating lesions by heating (RF) or freezing (cryoenergy) the tissue. Of note, it has been consistently demonstrated that RF ablation and cryoballoon ablation are equally effective and safe for treating patients with paroxysmal AF. However, cryoballoon ablation is more reproducible within groups than RF ablation. The outcomes of RF ablation are closely related to operator and center volumes. Furthermore, there can be significant variability in the number of ablation lesions created, the force applied by the tip of the catheter to the tissue—known as contact force—and the amount and duration of power delivery.
Ablation protocols have changed significantly during the last decade, particularly with respect to RF parameters. Conventional power settings were 20-35 W over 30-60 seconds. In recent years, high-power, short-duration (HPSD) protocols utilizing RF at power levels of 40-50 W for shorter durations have gained popularity.– Indeed, the HPSD technique is associated with shorter times to achieve PVI and greater freedom from AF recurrences, albeit with a trend towards more asymptomatic cerebral emboli.,
[…]
141