Journal of arrhythmia · 2026
Procedural Efficiency and Clinical Outcomes of a Region-Specific Radiofrequency Ablation Strategy for Pulmonary Vein Isolation.
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Silva Etel, Alba-Camacho Joaquín, Fernández-Rivero Rafael, Cano-Calabria Lucas, Lobo-Torres Iván, Golmaryami Saman, Solano-Mulero Ana María, Fernández-Armenta Juan
Аннотация
BACKGROUND: High-power short-duration radiofrequency ablation improves procedural efficiency during pulmonary vein isolation (PVI), but concerns remain regarding lesion transmurality and posterior wall collateral injury. We evaluated whether a region-specific ablation strategy was associated with improved procedural efficiency without a detected difference in acute efficacy or 12-month arrhythmia recurrence compared with conventional ablation index-guided PVI.
METHODS: In this retrospective single-center study, 250 patients undergoing first-time PVI were treated with either ablation index-guided ablation or a region-specific strategy using very high-power short-duration applications on the posterior wall and ablation index-guided lesions on the anterior wall. The primary endpoint was first-pass isolation, analyzed per pulmonary vein using generalized estimating equations to account for within-patient clustering. Secondary endpoints included procedural efficiency, peri-procedural safety, and 12-month arrhythmia recurrence.
RESULTS: First-pass isolation was achieved in 919 of 1 000 pulmonary veins (91.9%): 454 of 500 veins (90.8%) with the region-specific strategy and 465 of 500 veins (93.0%) with ablation index-guided ablation, with no significant between-group difference (OR, 0.74; 95% CI, 0.41-1.34; p = 0.322). The region-specific strategy was associated with shorter procedure duration, ablation time, radiofrequency time, fluoroscopy time, and lower radiation dose (all p < 0.001). Acute complications occurred in 4 patients (1.6%). At 12 months, arrhythmia recurrence occurred in 43 patients (17.2%), with no detected difference between strategies.
CONCLUSIONS: A region-specific ablation strategy improved procedural efficiency without a detected difference in first-pass isolation or 12-month arrhythmia recurrence compared with ablation index-guided PVI.
METHODS: In this retrospective single-center study, 250 patients undergoing first-time PVI were treated with either ablation index-guided ablation or a region-specific strategy using very high-power short-duration applications on the posterior wall and ablation index-guided lesions on the anterior wall. The primary endpoint was first-pass isolation, analyzed per pulmonary vein using generalized estimating equations to account for within-patient clustering. Secondary endpoints included procedural efficiency, peri-procedural safety, and 12-month arrhythmia recurrence.
RESULTS: First-pass isolation was achieved in 919 of 1 000 pulmonary veins (91.9%): 454 of 500 veins (90.8%) with the region-specific strategy and 465 of 500 veins (93.0%) with ablation index-guided ablation, with no significant between-group difference (OR, 0.74; 95% CI, 0.41-1.34; p = 0.322). The region-specific strategy was associated with shorter procedure duration, ablation time, radiofrequency time, fluoroscopy time, and lower radiation dose (all p < 0.001). Acute complications occurred in 4 patients (1.6%). At 12 months, arrhythmia recurrence occurred in 43 patients (17.2%), with no detected difference between strategies.
CONCLUSIONS: A region-specific ablation strategy improved procedural efficiency without a detected difference in first-pass isolation or 12-month arrhythmia recurrence compared with ablation index-guided PVI.