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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1552340

Optimized workflow for paroxysmal atrial fibrillation ablation using very High Power Short Duration

Provisionally accepted
Alberto Preda Alberto Preda *Lorenzo Gigli Lorenzo Gigli Alessio Testoni Alessio Testoni Alexios Sotirios Kotinas Alexios Sotirios Kotinas Andrea Tacchetto Andrea Tacchetto Fabrizio Guarracini Fabrizio Guarracini Marco Carbonaro Marco Carbonaro SARA Vargiu SARA Vargiu Marisa Varrenti Marisa Varrenti Giulia Colombo Giulia Colombo Roberto Menè Roberto Menè Matteo Baroni Matteo Baroni Antonio Frontera Antonio Frontera Patrizio Mazzone Patrizio Mazzone
  • De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, Italy, Milan, Italy

The final, formatted version of the article will be published soon.

    Background: wide antral pulmonary vein isolation (PVI) is effective for treating paroxysmal atrial fibrillation (PAF), although time-demanding. We investigated the impact of a standardized ablation protocol by using a bidirectional transeptal steerable sheath, high-density mapping and very high-power-shortduration (vHPSD) catheters on procedure timing, efficacy, and safety. Methods: consecutive PAF patients free from previous ablations undergoing PVI alone between January 2022 and March 2023 were prospectively enrolled. The standardized workflow included general anesthesia, a single transeptal puncture trough with a bidirectional, steerable visualizable sheath introduced into the left atrium accommodated a high density, penta-spline mapping catheter and a contact force sensor ablation catheter enabled to deliver vHPSD. Procedural data and electrophysiology (EP) laboratory times were systematically collected and analyzed. The primary endpoint was any AF or atrial tachycardia recurrence at 12 and 24 month follow up.Results: the study cohort was composed by 138 patients (mean age was 59 ± 11 years, 38% female) and successful PVI was achieved in 100% of cases. Overall, first pass isolation (PFI) was 93%, with a LA dwell time of 32 ± 4 min. Significant complications were reported in 3% of patients. Skin-to-skin time and total EP laboratory time were 58 ± 5 min and 85 ± 7 min, respectively. The primary endpoint was achieved by 9% and 12% of cases at 12 and 24 month follow up, respectively. Upper limit skin-to-skin time and missed FPI resulted predictors of the primary endpoint.This standardized workflow resulted in low procedural times and arrhythmias recurrence without compromising the safety.

    Keywords: Atrial fibrillation ablation, Paroxysmal atrial fibrillation, high power short duration, Steerable catheter, near zero fluoro ablation

    Received: 27 Dec 2024; Accepted: 20 Jan 2025.

    Copyright: © 2025 Preda, Gigli, Testoni, Kotinas, Tacchetto, Guarracini, Carbonaro, Vargiu, Varrenti, Colombo, Menè, Baroni, Frontera and Mazzone. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Alberto Preda, De Gasperis Cardio Center, Electrophysiology Unit, Niguarda Hospital, Milan, Italy, Milan, Italy

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