Arrhythmias & electrophysiology
Three ablation strategies using very high-power short-duration catheter in paroxysmal atrial fibrillation: The Q-INDEX randomized trial
Authors' conclusion
Uniform vHPSD more than halved PVI ablation time but was associated with the lowest 1-year efficacy, whereas the hybrid strategy preserved efficiency without significant loss of durability. These exploratory findings-from a trial powered for ablation time-support region-tailored lesion depth in point-by-point ablation and warrant confirmation.
Study context
- Population
- Patients with paroxysmal atrial fibrillation undergoing pulmonary vein isolation (PVI) with the QDOT MICRO catheterpatients randomized
- Participants
- 150 patients
- Comparison
- Very high-power short-duration (vHPSD), ablation index (AI)-guided, and hybrid strategies for PVI in paroxysmal atrial fibrillation
- Primary endpoint
- Total ablation time
Methodological details1:1:1 allocation
- 1:1:1 allocation
Primary result
As reported in the abstract
P < 0.001) across the three groups
Secondary outcomes
Acute reconnection across the 14 PV segments · secondary endpoint
Freedom from atrial arrhythmia · 1 year · secondary endpoint
- Acute reconnection across the 14 PV segments: P = .40
- Freedom from atrial arrhythmia: log-rank P = .13
- Freedom from atrial arrhythmia: AI-guided vs vHPSD P = .049
Acute PVI
- Acute PVI was achieved in all patients
Safety
Silent cerebral lesions on magnetic resonance imaging · did not differ among the groups
- Silent cerebral lesions on magnetic resonance imaging: P = .35
Tamponade and steam pops
- No tamponade occurred
- Steam pops occurred only in the 90 W groups
Minor periprocedural stroke
- Two minor periprocedural strokes (both vHPSD; full recovery)
- Two
Original publication
Summarised from the published abstract; every number is checked against it