Procedural Efficiency and Clinical Outcomes of a Region-Specific Radiofrequency Ablation Strategy for Pulmonary Vein Isolation.

Background: High-power short-duration radiofrequency ablation improves procedural efficiency during pulmonary vein isolation (PVI), but concerns remain regarding lesion transmurality and posterior wall collateral injury. We evaluated whether a region-specific ablation strategy was associated with improved procedural efficiency without a detected difference in acute efficacy or 12-month arrhythmia recurrence compared with conventional ablation index-guided PVI. Methods: In this retrospective single-center study, 250 patients undergoing first-time PVI were treated with either ablation index-guided ablation or a region-specific strategy using very high-power short-duration applications on the posterior wall and ablation index-guided lesions on the anterior wall. The primary endpoint was first-pass isolation, analyzed per pulmonary vein using generalized estimating equations to account for within-patient clustering. Secondary endpoints included procedural efficiency, peri-procedural safety, and 12-month arrhythmia recurrence. Results: First-pass isolation was achieved in 919 of 1 000 pulmonary veins (91.9%): 454 of 500 veins (90.8%) with the region-specific strategy and 465 of 500 veins (93.0%) with ablation index-guided ablation, with no significant between-group difference (OR, 0.74; 95% CI, 0.41-1.34; Conclusions: A region-specific ablation strategy improved procedural efficiency without a detected difference in first-pass isolation or 12-month arrhythmia recurrence compared with ablation index-guided PVI.