High-power short-duration versus low-power long-duration ablation for pulmonary vein isolation : A substudy of the AWARE randomized controlled trial
© 2023 Wiley Periodicals LLC..
INTRODUCTION: Pulmonary vein isolations (PVI) are being performed using a high-power, short-duration (HPSD) strategy. The purpose of this study was to compare the clinical efficacy and safety outcomes of an HPSD versus low-power, long-duration (LPLD) approach to PVI in patients with paroxysmal atrial fibrillation (AF).
METHODS: Patients were grouped according to a HPSD (≥40 W) or LPLD (≤35 W) strategy. The primary endpoint was the 1-year recurrence of any atrial arrhythmia lasting ≥30 s, detected using three 14-day ambulatory continuous ECG monitoring. Procedural and safety endpoints were also evaluated. The primary analysis were regression models incorporating propensity scores yielding adjusted relative risk (RRa ) and mean difference (MDa ) estimates.
RESULTS: Of the 398 patients included in the AWARE Trial, 173 (43%) underwent HPSD and 225 (57%) LPLD ablation. The distribution of power was 50 W in 75%, 45 W in 20%, and 40 W in 5% in the HPSD group, and 35 W with 25 W on the posterior wall in the LPLD group. The primary outcome was not statistically significant at 30.1% versus 22.2% in HPSD and LPLD groups with RRa 0.77 (95% confidence interval [CI]) 0.55-1.10; p = .165). The secondary outcome of repeat catheter ablation was not statistically significant at 6.9% and 9.8% (RRa 1.59 [95% CI 0.77-3.30]; p = .208) respectively, nor was the incidence of any ECG documented AF during the blanking period: 1.7% versus 8.0% (RRa 3.95 [95% CI 1.00-15.61; p = .049) in the HPSD versus LPLD group respectively. The total procedure time was significantly shorter in the HPSD group (MDa 97.5 min [95% CI 84.8-110.4)]; p < .0001) with no difference in adjudicated serious adverse events.
CONCLUSIONS: An HPSD strategy was associated with significantly shorter procedural times with similar efficacy in terms of clinical arrhythmia recurrence. Importantly, there was no signal for increased harm with a HPSD strategy.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:35 |
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| Enthalten in: |
Journal of cardiovascular electrophysiology - 35(2024), 1 vom: 21. Jan., Seite 136-145 |
| Sprache: |
Englisch |
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| Links: |
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| Themen: |
Ablation index |
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| Anmerkungen: |
Date Completed 10.01.2024 Date Revised 10.01.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/jce.16123 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM364817283 |
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| 100 | 1 | |a Joza, Jacqueline |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a High-power short-duration versus low-power long-duration ablation for pulmonary vein isolation |b A substudy of the AWARE randomized controlled trial |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 10.01.2024 | ||
| 500 | |a Date Revised 10.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 Wiley Periodicals LLC. | ||
| 520 | |a INTRODUCTION: Pulmonary vein isolations (PVI) are being performed using a high-power, short-duration (HPSD) strategy. The purpose of this study was to compare the clinical efficacy and safety outcomes of an HPSD versus low-power, long-duration (LPLD) approach to PVI in patients with paroxysmal atrial fibrillation (AF) | ||
| 520 | |a METHODS: Patients were grouped according to a HPSD (≥40 W) or LPLD (≤35 W) strategy. The primary endpoint was the 1-year recurrence of any atrial arrhythmia lasting ≥30 s, detected using three 14-day ambulatory continuous ECG monitoring. Procedural and safety endpoints were also evaluated. The primary analysis were regression models incorporating propensity scores yielding adjusted relative risk (RRa ) and mean difference (MDa ) estimates | ||
| 520 | |a RESULTS: Of the 398 patients included in the AWARE Trial, 173 (43%) underwent HPSD and 225 (57%) LPLD ablation. The distribution of power was 50 W in 75%, 45 W in 20%, and 40 W in 5% in the HPSD group, and 35 W with 25 W on the posterior wall in the LPLD group. The primary outcome was not statistically significant at 30.1% versus 22.2% in HPSD and LPLD groups with RRa 0.77 (95% confidence interval [CI]) 0.55-1.10; p = .165). The secondary outcome of repeat catheter ablation was not statistically significant at 6.9% and 9.8% (RRa 1.59 [95% CI 0.77-3.30]; p = .208) respectively, nor was the incidence of any ECG documented AF during the blanking period: 1.7% versus 8.0% (RRa 3.95 [95% CI 1.00-15.61; p = .049) in the HPSD versus LPLD group respectively. The total procedure time was significantly shorter in the HPSD group (MDa 97.5 min [95% CI 84.8-110.4)]; p < .0001) with no difference in adjudicated serious adverse events | ||
| 520 | |a CONCLUSIONS: An HPSD strategy was associated with significantly shorter procedural times with similar efficacy in terms of clinical arrhythmia recurrence. Importantly, there was no signal for increased harm with a HPSD strategy | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ablation index | |
| 650 | 4 | |a atrial fibrillation | |
| 650 | 4 | |a pulmonary vein isolation | |
| 700 | 1 | |a Nair, Girish M |e verfasserin |4 aut | |
| 700 | 1 | |a Birnie, David H |e verfasserin |4 aut | |
| 700 | 1 | |a Nery, Pablo B |e verfasserin |4 aut | |
| 700 | 1 | |a Redpath, Calum J |e verfasserin |4 aut | |
| 700 | 1 | |a Sarrazin, Jean-Francois |e verfasserin |4 aut | |
| 700 | 1 | |a Champagne, Jean |e verfasserin |4 aut | |
| 700 | 1 | |a Bernick, Jordan |e verfasserin |4 aut | |
| 700 | 1 | |a Wells, George A |e verfasserin |4 aut | |
| 700 | 1 | |a Essebag, Vidal |e verfasserin |4 aut | |
| 700 | 0 | |a other members of the AWARE Study Consortium (Augmented Wide Area Circumferential Catheter Ablation for Reduction of Atrial Fibrillation Recurrence) |e verfasserin |4 aut | |
| 700 | 1 | |a Roux, Jean-Francois |e investigator |4 oth | |
| 700 | 1 | |a Dussault, Charles |e investigator |4 oth | |
| 700 | 1 | |a Parkash, Ratika |e investigator |4 oth | |
| 700 | 1 | |a Bernier, Martin |e investigator |4 oth | |
| 700 | 1 | |a Sterns, Laurence D |e investigator |4 oth | |
| 700 | 1 | |a Sapp, John |e investigator |4 oth | |
| 700 | 1 | |a Novak, Paul |e investigator |4 oth | |
| 700 | 1 | |a Veenhuyzen, George |e investigator |4 oth | |
| 700 | 1 | |a Morillo, Carlos A |e investigator |4 oth | |
| 700 | 1 | |a Singh, Sheldon M |e investigator |4 oth | |
| 700 | 1 | |a Sadek, Mouhannad M |e investigator |4 oth | |
| 700 | 1 | |a Golian, Mehrdad |e investigator |4 oth | |
| 700 | 1 | |a Klein, Andres |e investigator |4 oth | |
| 700 | 1 | |a Sturmer, Marcio |e investigator |4 oth | |
| 700 | 1 | |a Chauhan, Vijay S |e investigator |4 oth | |
| 700 | 1 | |a Angaran, Paul |e investigator |4 oth | |
| 700 | 1 | |a Green, Martin S |e investigator |4 oth | |
| 700 | 1 | |a Joza, Jacqueline |e investigator |4 oth | |
| 700 | 1 | |a Nair, Girish M |e investigator |4 oth | |
| 700 | 1 | |a Birnie, David H |e investigator |4 oth | |
| 700 | 1 | |a Nery, Pablo B |e investigator |4 oth | |
| 700 | 1 | |a Redpath, Calum J |e investigator |4 oth | |
| 700 | 1 | |a Sarrazin, Jean-Francois |e investigator |4 oth | |
| 700 | 1 | |a Champagne, Jean |e investigator |4 oth | |
| 700 | 1 | |a Bernick, Jordan |e investigator |4 oth | |
| 700 | 1 | |a Wells, George A |e investigator |4 oth | |
| 700 | 1 | |a Essebag, Vidal |e investigator |4 oth | |
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