A Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation - SHORT-AF

Jul 24, 2023
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Kim A. Eagle, MD, MACC
Trial Sponsor:
Tod Spieker philanthropic fund
Date Published:
02/22/2023
Date Updated:
07/24/2023
Original Posted Date:
07/24/2023
References

Contribution To Literature:

The SHORT-AF trial showed that high-power short-duration radiofrequency ablation shortens the time to achieve pulmonary vein isolation and greater freedom from atrial fibrillation.

Description:

The goal of the trial was to evaluate high-power short-duration radiofrequency ablation compared with standard-power standard-duration radiofrequency ablation among patients undergoing pulmonary vein isolation.

Study Design

  • Randomized
  • Parallel

Patients with atrial fibrillation undergoing pulmonary vein isolation were randomized to high-power short-duration radiofrequency ablation (n = 29) vs. standard-power standard-duration radiofrequency ablation (n = 31).

  • Total number of enrollees: 60
  • Duration of follow-up: 12 months
  • Mean patient age: 67 years
  • Percentage female: 31%
  • Percentage with diabetes: 7%

Inclusion criteria:

  • Patients ≥18 years of age undergoing pulmonary vein isolation for paroxysmal/persistent atrial fibrillation

Exclusion criteria:

  • Prior ablation procedure
  • Stroke/transient ischemic attack within the past 6 months
  • Valvular atrial fibrillation
  • Mechanical mitral valve replacement
  • Left ventricular ejection fraction <35%
  • Prior patent foramen ovale or atrial septal defect closure device
  • Cardiac implantable electronic device or any contraindication to magnetic resonance imaging

Principal Findings:

The primary outcome, time to achieve pulmonary vein isolation, was 87 minutes in the high-power group vs. 126 minutes in the standard-power group (p = 0.003).

Secondary outcomes:

  • Recurrent atrial arrhythmia at 12 months: 10% in the high-power group vs. 35% in the standard-power group (p = 0.027)
  • Asymptomatic cerebral emboli: 40% in the high-power group vs. 17% in the standard-power group (p = 0.053)

Interpretation:

Among patients with paroxysmal/persistent atrial fibrillation, high-power short-duration radiofrequency ablation shortens the time for pulmonary vein isolation and reduced the incidence of recurrent atrial arrhythmia at 12 months compared with standard-power standard-duration radiofrequency ablation. High-power short-duration radiofrequency ablation was associated with an increased incidence of asymptomatic cerebral emboli compared with standard-power standard-duration radiofrequency ablation.

References:

Lee AC, Voskoboinik A, Cheung CC, et al. A Randomized Trial of High vs Standard Power Radiofrequency Ablation for Pulmonary Vein Isolation: SHORT-AF. JACC Clin Electrophysiol 2023;9:1038-47.

Editorial Comment: Garber L, Barbhaiya C. High Power Short Duration: Is There a Chink in the Armor? JACC Clin Electrophysiol 2023;9:1048-50.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Ablation Techniques, Arrhythmias, Cardiac, Atrial Fibrillation, Embolism, Pulmonary Veins, Radiofrequency Ablation


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