Is high-power radiofrequency ablation of atrial fibrillation less
painful than standard approach in conscious patients?
Abstract
Background: High-power radiofrequency ablation (HPRFA) appears to be a
novel concept for atrial fibrillation (AF) treatment but there are
scarce data in conscious patients. The lesion size index (LSI) value has
been associated with durability of pulmonary vein isolation (PVI)
lesions. Objectives: We hypothesised that HPRFA applications based on
LSI were not inferior to standard approach in terms of patient’s pain
sensationas well as safety, effectiveness, and procedure duration.
Methods: Retrospectively, we analysed 218 patients who had performed
ablation of AF based on LSI (LSI 4-4.5 on posterior wall, LSI 5-5.5 in
other locations) who were propensity score matched to 3 different RF
power settings: group-30W (45oC, 30 W and 25 W on posterior wall),
group-40W (45oC, 40 W) and group-50W (45oC, 50 W). Results: Comparing
group-30W vs group-40W and group-50W, procedure and left atrium dwell
time (minutes) were 190±32, 161±41, 102±8 (p<0.0001) and
154±53, 113±29, 79±10 (p<0.0001), respectively. With
comparable number of RF applications (p>0.05) between the
groups, total RF and fluoroscopy time (minutes) were 62±17,38±10, 28±5
(p<0.0001) and 6±3, 6±2, 4±1 (p=0.08), respectively. Number of
stopped painful RF applications were 19±9, 9±5 and 7±2
(p<0.0001), respectively. No serious complications were
observed in any of the group. No difference in 1-year ablation efficacy
was observed between the groups (p=0.78). Conclusions: HPRFA based on
LSI is less painful, faster and safe in conscious patients than standard
approach with comparable effectiveness in one year follow-up.