Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study

Szegedi, N; Salló, Z; Nagy, VK; Osztheimer, I; Hizoh, I; Lakatos, B; Boussoussou, M; Orbán, G; Boga, M; Ferencz, AB; Komlósi, F; Tóth, P; Perge, P; Kovács, A; Merkely, B; Gellér, L

doi:10.1161/circep.123.012402

Arrhythmias & electrophysiology

Long-Term Durability of High- and Very High-Power Short-Duration Pulmonary Vein Isolation (PVI) by Invasive Remapping: The HPSD Remap Study

Circ Arrhythm ElectrophysiolPublished 29 Jan 2024Randomised controlled trial

Primary result · Durable PVI per PVResultEffect size 0.040 95% CI lower bound −0.051

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Authors' conclusion

Similarly high rates of durable PVI and arrhythmia-free survival were achieved with 90 and 50 W. Procedure, left atrial dwell, and radiofrequency times were shorter with 90 W compared with 50 W.

Study context

Population: Patients undergoing PVI for AF40 had repeat EP study
Participants: 46 patients

Comparison: 90-W vs 50-W power setting for PVI
Primary endpoint: Durable PVI on a per PV basis at repeat electrophysiology study
Follow-up: 3 months

Methodological detailsnon-inferiority

Non-inferiority

Primary result

Durable PVI per PV

Effect size

0.040

95% CI lower bound −0.051

Events by treatment group

90 W92%72/78 events

50 W88%68/77 events

As reported in the abstract

Further findings

First-pass isolation and acute reconnection

First-pass isolation

90 W83%

50 W82%

Acute reconnection

90 W4%

50 W14%

Outcome	90 W	50 W
Procedure, left atrial dwell and radiofrequency times
Procedure time	76 minutes	84 minutes
Left atrial dwell time	63 minutes	71 minutes
Radiofrequency time	303 seconds	1040 seconds
Radiofrequency applications	77	67

Procedure, left atrial dwell and radiofrequency times: Procedure time P =0.02
Procedure, left atrial dwell and radiofrequency times: Left atrial dwell time P =0.01
Procedure, left atrial dwell and radiofrequency times: Radiofrequency time P <0.0001
Procedure, left atrial dwell and radiofrequency times: Radiofrequency applications P =0.01
First-pass isolation and acute reconnection: First-pass isolation P =1.0
First-pass isolation and acute reconnection: Acute reconnection P =0.3

AF-free survival · 12 months

No difference between 90 W and 50 W: P = 0.2

Safety

No complications occurred

Original publication

Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study. Circ Arrhythm Electrophysiol. Published 29 January 2024. doi:10.1161/circep.123.012402

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