Very High-Power Short-Duration Radiofrequency Ablation for Atrial Fibrillation: A Review of Technical Principles and Clinical Practice

DOI: https://doi.org/10.62517/jmhs.202505406

Author(s)

Xiaoyu He1,2, Yajiang Zhang1, Kun Jiao1, Changqing Li1, Ping Su1, Peng Liu1,*

Affiliation(s)

1Department of Cardiology, Ordos Cental Hospital, Ordos, Inner Mongolia, China 2Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China *Corresponding Author

Abstract

As a pervasive cardiac arrhythmia with escalating global incidence, atrial fibrillation (AF) substantially elevates the risks of stroke and heart failure. Within the therapeutic arsenal, catheter-based pulmonary vein isolation (PVI) constitutes the cornerstone interventional strategy. Conventional radiofrequency ablation utilizing 30-50 W over 20-60 seconds per lesion, depends on conductive heating. This often leads to prolonged procedures, uneven lesion formation, and complications like esophageal injury. Very high-power short-duration (vHPSD) ablation is defined by 90 W applications lasting 4 seconds. represents a paradigm shift by favoring "resistive heating." This mechanism creates wider, shallower lesions that are theoretically better suited to the thin left atrial walls, enhancing efficiency and potentially reducing risks. This review synthesizes recent evidence on vHPSD's technical principles, dedicated systems like the QDOT MICRO catheter, clinical efficacy, and safety. vHPSD markedly shortens procedure, ablation, and fluoroscopy times while achieving PVI success rates >99.5%. Its long-term efficacy is non-inferior to conventional ablation, with 12-month sinus rhythm maintenance rates of 76-78%. vHPSD notably reduces serious esophageal injury risk. However, silent cerebral embolism (incidence 8-26%) and early catheter tip coagulum (since optimized to 0.8%) require attention. In conclusion, vHPSD signifies a progressive evolution towards safer, more efficient AF ablation. Future large-scale, long-term trials are needed to confirm lesion durability, standardize parameters, and develop personalized, image-guided strategies, solidifying its role in the therapeutic arsenal.

Keywords

Atrial Fibrillation; Catheter Ablation; Pulmonary Vein Isolation; Silent Cerebral Embolism

References

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