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Introduction: High-power short-duration (HPSD; 50W for up to 15s) ablation is a novel way to use a contact force-sensing catheter optimized for power-controlled radiofrequency ablation of atrial fibrillation (AF). Our goal was to compare the procedural and clinical outcomes of AF ablation with HPSD to previous ablation methods used, including standard-power standard duration (SPSD; 20-25W, up to 60s) and temperature-controlled non-contact (TCNC; 20-40W, up to 60s).

Methods: Procedural and clinical data was from consecutive cases of patients with paroxysmal or persistent AF undergoing pulmonary vein isolation with HPSD, TCNC and SPSD between 7/1/13 to 11/1/19. A total of 171 patients were studied (76 HPSD, 44 TCNC, 51 SPSD).

Results: There was no difference in age, sex, or AF type between groups. Radiofrequency ablation time was shorter when comparing HPSD to SPSD (71 vs 101min; p<0.01), HPSD to TCNC (71 vs 146min; p<0.01), and SPSD to TCNC groups (101 vs 146min; p<0.01). There was no difference in sinus rhythm maintenance after 3 or 12-months between groups overall, and when stratified by AF type, left atrial volume, CHA2DS2-VASc score, or left ventricular EF. There was a numerical difference in safety with no adverse events in HPSD (0/76 in HPSD vs 1/51 in SPSD vs 3/44 in TCNC; p=0.06).

Discussion: AF ablation utilizing HPSD ablation reduced procedure times with similar sinus rhythm maintenance compared to SPSD and TCNC ablation. This supports the movement to replace SPSD and TCNC with the novel HPSD approach. Further research is warranted with larger populations and longer follow-up.