High-Power Short-Duration Radiofrequency Application for Faster and Safer Pulmonary Vein Isolation: The POWER-FAST III Trial.

Autores de IIS La Fe

• Joaquín Osca Asensi

  Autor

• Angel Moya Herraiz

  Autor

Participantes ajenos a IIS La Fe

• Castrejon-Castrejon, Sergio
• Martinez Cossiani, Marcel
• Basterra Sola, Nuria
• Romero Roldan, Javier David
• Ibanez Criado, Jose Luis
• Roca-Luque, Ivo
• Quesada, Aurelio
• Hidalgo Olivares, Victor Manuel
• Perez Castellano, Nicasio
• Fernandez-Gomez, Juan Manuel
• Macias-Ruiz, Rosa
• Villanueva, Bruno Bochard
• Gonzalo Bada, Nerea
• Froilan Torres, Consuelo
• Sanz Verdejo, Beatriz
• Sanchez Somonte, Paula
• Escobar Cervantes, Carlos
• Moreno, Raul
• Merino, Jose Luis
• POWER FAST III Trial Investigators

Grupos

• Grupo de Investigación Clínica y Traslacional en Cardiología

Abstract

BACKGROUND: The optimal radiofrequency application (RFa) parameters for safe and durable pulmonary vein isolation (PVI) are debated. High-power short-duration (HPSD) has been used as an alternative to conventional power delivery (CPD). OBJECTIVES: This study sought to compare HPSD 70 W/9-10 s (HPSD-70) with CPD 25-40W in patients undergoing PVI. METHODS: Patients were randomized to HPSD-70 or CPD (25-40). The primary outcomes were freedom from atrial arrhythmia recurrences and the incidence of esophageal thermal lesions (EDELs) after ablation. RESULTS: Among 304 patients randomized, 301 remained in the study (median age: 61 years; Q1-Q3: 53-69 years; 72% men): 294 patients (97.7%) underwent ablation, 285 (94.7%) underwent endoscopy, and 290 (98.6%) completed the follow-up. At 12months, 100 patients (73.5%) in the CPD (25-40) group and 87 patients (67%) in the HPSD-70 group were free from recurrences off antiarrhythmic drugs (HR: 1.28; 95%CI: 0.82-1.99; P=0.28). The incidences of EDELs were 2.7% in the CPD (25-40) group and 3.6% in the HPSD-70 group (P=0.94). Median left atrial dwell (153 vs 137min; P=0.03) and total RF times for definitive PVI (31 vs 11.2min; P< 0.001) were shorter with HPSD-70 ablation. Four symptomatic embolic events (2 strokes, 1 transient ischemic attack, and 1 splenic infarct) occurred with HPSD-70 and none with CPD (25-40) RFa (P=0.056). CONCLUSIONS: HPSD-70 RFa was noninferior to prevent arrhythmia recurrences, and the incidence of EDELs was similar compared with CPD (25-40) RFa. The embolic events were numerically higher in the HPSD-70 group. (High Radiofrequency Power for Faster and Safer Pulmonary Vein Ablation Trial [POWER FAST III]; NCT04153747).

Copyright © 2025 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Keywords

• ablation; atrial fibrillation; embolism; esophageal lesions; high-power; radiofrequency