Safety and Efficacy of High-Power Short-Duration Radiofrequency Ablation (50W) in Patients with Paroxysmal Atrial Fibrillation

Background Pulmonary vein isolation (PVI) using conventional power radiofrequency ablation (RFA) has been an effective treatment strategy for paroxysmal atrial fibrillation (PAF), but its longer duration may cause collateral damage to peripheral tissue. High-power RFA, characterized by better transmural performance and reduced collateral damage due to its shorter duration, has sparked a safety and efficacy controversy that still needs further evaluation. Methods In this retrospective cohort study, we included 259 patients with PAF who were had performed for lesion size index (LSI)-guided radiofrequency ablation. A total of 119 PAF patients underwent 50 W ablation. Complications and twelve-month arrhythmia-free outcomes of the procedure were compared with 140 patients who underwent 30–35 W ablation. Results PVI was successfully achieved in all patients. The procedural duration (140.3 ± 34.4 vs. 151.3 ± 40.6 min, P = 0.022) and overall radiation (112.0 ± 67.2 vs. 188.2 ± 119.2 mGy, P < 0.001) were significantly lower in the 50 W group. No major complications occurred in the high-power short-duration (HPSD) group. The recurrence of arrhythmia at the twelve-month follow-up was not significantly different between the two groups [11 (9.2%) vs. 19 (13.6%), P = 0.278)]. Conclusion LSI-guided HPSD-RFA demonstrated comparable safety and efficacy for conventional ablation and resulted in reduced procedure time and radiation exposure.