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

Fecha de publicación: Fecha Ahead of Print:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Castrejón-Castrejón, S
  • Cossiani, MM
  • Sola, NB
  • Roldán, JDR
  • Criado, JLI
  • Roca-Luque, I
  • Moya, A
  • Quesada, A
  • Olivares, VMH
  • Castellano, NP
  • Fernández-Gómez, JM
  • Macías-Ruiz, R
  • Villanueva, BB
  • Bada, NG
  • Torres, CF
  • Verdejo, BS
  • Somonte, PS
  • Cervantes, CE
  • Moreno, R
  • Merino, JL
  • POWER FAST III Trial Investigators

Grupos

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 25-40 Win 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 12 months, 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 137 min; P = 0.03) and total RF times for definitive PVI (31 vs 11.2 min; 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) (c) 2025 by the American College of Cardiology Foundation.

Datos de la publicación

ISSN/ISSNe:
2405-500X, 2405-5018

JACC-Clinical Electrophysiology  ELSEVIER

Tipo:
Article
Páginas:
350-361
PubMed:
39708035
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
2,115 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 11

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Keywords

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

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