• Gurpreet Dhillon, Syed Ahsan, Shohreh Honarbakhsh, Wei Lim, Marco Baca, Adam Graham, Neil Srinivasan, Vinit Sawhney, Simon Sporton, Richard J Schilling, Anthony Chow, Matthew Ginks, Manav Sohal, Mark M Gallagher, and Ross J Hunter.
• Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
• J. Cardiovasc. Electrophysiol. 2019 Mar 1; 30 (3): 357-365.

BackgroundPulmonary vein isolation (PVI) using high power delivered by SmartTouch Surround Flow (STSF) catheters guided by ablation index (AI) was evaluated in a multicenter registry.MethodsPatients with paroxysmal AF underwent PVI with STSF catheters using 30 W on the posterior wall and 40 W elsewhere. AI targets were 350 posterior walls and 450 elsewhere. Procedures were compared with controls using conventionally irrigated contact force-sensing catheters using conventional powers (25 W posterior wall and 30 W elsewhere) guided by force-time integral (no agreed targets). The waiting period of 30 minutes was observed before adenosine administration to assess acute pulmonary vein (PV) reconnection.ResultsOne hundred patients from four centers were included: 50 patients in the high power ablation index (HPAI) group and 50 controls. Procedure time was 22% shorter in the HPAI group (156 [133.8-179] vs 199 [178.5-227] minutes; P < 0.001). Duration of the radiofrequency application was 37% shorter in the HPAI group (27.2 [21.5-35.8] vs 43.2 [35.1-52.1] minutes; P < 0.001). Acute PV reconnection was reduced (28 of 200 [14%] vs 48 of 200 [24%] veins; P = 0.015). Reconnection was predicted by a largest interlesion distance greater than 6 mm, a lesion with impedance drop less than 2.5 Ω, contact force less than 6 g, or less than 68% of the regional AI target (all P < 0.001). Freedom from atrial arrhythmia at 1 year off antiarrhythmic drugs after a single procedure was 78% in the HPAI group vs 64% in the control group ( P = 0.186).ConclusionHigh-powered ablation guided by AI was safe and led to shorter procedure times with reduced acute PV reconnection compared with conventional ablation.© 2018 Wiley Periodicals, Inc.

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