LAUSR

BACKGROUND Little is known about the long-term outcomes and predictors of success for High Power Short Duration(HPSD) Contact Force(CF) atrial fibrillation(AF) ablations. OBJECTIVES To determine long-term freedom from AF and predictors of freedom from AF for 50W 5-15 second CF ablation. METHODS We examined 4-year outcomes and predictors of freedom from AF after AF ablation for 1250 consecutive patients undergoing HPSD CF ablations. RESULTS The demographic were: age=66.6±10.5, female=30.9%, LA size=4.26±0.66 cm, paroxysmal AF=35.7%, persistent AF=56.6%, longstanding AF=7.7%. The initial ablation times were: procedure 114.2±45.9 min, fluoroscopy 15.5±11.5 min, total RF 20.6±7.7 minutes. We used TactiCath™ in 47.7%, SmartTouch® in 52.3% and posterior wall isolation(PWI) in 34%. The 4-year freedom from AF after multiple ablations were paroxysmal AF: 87.0%, persistent AF: 71.9% and longstanding AF: 64.9%. Single procedure success was 74.9% for TactiCath™ and 64.7% for SmartTouch®(P<0.001) and was 73.0% for no PWI vs 58.9% for PWI(P=<0.0001). PWI did not change outcomes for paroxysmal AF, but had worse outcomes for non-paroxysmal AF. Multivariate analysis showed 6 independent predictors of worse outcome after initial ablation: older age(P=0.014), female gender(P<0.0001), persistent AF(P=0.0001), larger LA size(P<0.001), PW isolation(0.049) and use of SmartTouch® vs. TactiCath™ catheter(P=0.007). Redo ablations were done in 13.8% and the outcome was better when more veins had reconnected after the initial ablation and when AF was paroxysmal. CONCLUSIONS Using HPSD CF for AF ablation there were 6 independent predictors of outcome. At redo ablations, the outcome was better if more veins had reconnected and could be re-isolated.