Effectiveness of first-pass pulmonary vein isolation with index-guided ablation compared to very-high-power, short-duration ablation: A retrospective single-center study.

Background: Pulmonary vein isolation is the cornerstone of atrial fibrillation treatment. First-pass pulmonary vein isolation is defined as isolation achieved with only a single lesion in every part of the isolation lines.

Aims: The primary aim was to assess the frequency of first-pass pulmonary vein isolation after ablation index-guided (AI) and very-high-power, short-duration (vHPSD) ablation. The secondary goals were to detect areas of additional lesions and the correlation between them and used methods and to access efficiency of the procedure.

Methods: In this retrospective, single-center study, we included 105 consecutive patients undergoing pulmonary vein isolation for paroxysmal or persistent atrial fibrillation. Based on the operators' decisions, 51 patients underwent AI-guided, and 54 patients underwent vHPSD ablation. The ipsilateral pulmonary veins were divided into four areas, and the anatomical region and several additional applications were evaluated.

Results: Bilateral first-pass pulmonary vein isolation was achieved in 34.3% of patients, with no significant difference between AI-guided and vHPSD ablation (37.0% vs. 31.4%; P = 0.68). In both groups, the most common region of additional applications was the posterior part of the right-sided carina (AI: 25.5% [13/51] vs. vHPSD: 25.9% [14/54]; P = 0.89). There was a significant difference (P = 0.049) between techniques in the highest frequency of additional applications in the left-sided pulmonary veins: in the anterior part of the carina (AI: 15.7% vs. vHPSD: 7.4%) and the posterior part of the carina (AI: 5.9% vs. vHSPD: 22.2%).

Conclusions: Lesions made with AI-guided and vHPSD protocols differed in areas of additional applications, which was most significant in the left-sided pulmonary veins.