Predictors of first-pass pulmonary vein isolation during very high-power short-duration radiofrequency ablation: a comparison of 90W and 50W protocols

Introduction

First-pass pulmonary vein isolation (FPI) is an important quality marker of atrial fibrillation (AF) ablation, reflecting lesion efficacy and continuity. Very high-power, short-duration

(vHPSD) radiofrequency ablation (RFA) has been developed to enhance procedural efficiency while maintaining durable lesion formation. This study aimed to assess the incidence and predictors of left- and right-sided FPI during 90W (vHPSD) and 50W (HPSD) RFA.

Methods

In this prospective study, 180 patients undergoing point-by-point pulmonary vein isolation

were included and stratified by applied power (90W vs. 50W). Clinical and procedural parameters were analyzed to identify predictors of FPI using univariate and multivariate logistic regression models.

Results

Procedural duration was significantly shorter with 90W compared to 50W (38.7±8.7 min vs.

58.9±15.6 min; p≤0.001). The time intervals from vascular access to mapping, mapping to ablation, and ablation to validation were all shorter with 90W (p≤0.001). Left-sided FPI rates were similar between groups (93.3% vs. 93.3%; p = 1.00), while right-sided FPI was more frequent with 90W (97.1% vs. 89.3%; p=0.031). On univariate analysis, longer procedural duration was a negative predictor of left-sided FPI (OR=0.95; p=0.003). For right-sided FPI, in multivariate analysis, the use of 50W power

was an independent negative predictor (OR=0.23; p=0.04).

Conclusion

Ablation using 90W vHPSD RFA achieved shorter procedure times and higher right-sided

FPI rates compared with 50W ablation. Procedural duration and applied power level were independent predictors of successful first-pass isolation.