Where is the gap after a 90 W/4 s very‐high‐power short‐duration ablation of atrial fibrillation?: Association with the left atrial‐pulmonary vein voltage and wall thickness

Abstract Background Although pulmonary vein isolation (PVI) for atrial fibrillation (AF) utilizing radiofrequency (RF) applications with a very high‐power and short‐duration (vHPSD) has shortened the procedure time, the determinants of pulmonary vein (PV) gaps in the first‐pass PVI and acute PV reconnections are unclear. Methods An extensive encircling PVI was performed with the QDOT MICRO catheter with a vHPSD (90 W–4 s) in 30 patients with AF (19 men, 64 ± 10 years). The association of the PV gap sites (first‐pass PVI failure, acute PV reconnections [spontaneous reconnections or dormant conduction provoked by adenosine triphosphate] or both) with the left atrial (LA) wall thickness and LA bipolar voltage on the PVI line and ablation‐related parameters were assessed. Results PV gaps were observed in 29 (6%) of 480 segments (16 segments per patient) in 17 patients (56%). The PV gaps were associated with the LA wall thickness, bipolar voltage, and the number of RF points (LA wall thickness, 2.5 ± 0.5 vs. 1.9 ± 0.4 mm, p < .001; bipolar voltage, 2.59 ± 1.62 vs. 1.34 ± 1.14 mV, p < .001; RF points, 6 ± 2 vs. 4 ± 2, p = .008) but were not with the other ablation‐related parameters. Receiver operating characteristic curves yielded that an LA wall thickness ≥2.3 mm and bipolar voltage ≥2.40 mV were determinants of PV gaps with an area under the curve of 0.82 and 0.73, respectively. Conclusions The LA voltage and wall thickness on the PV‐encircling ablation line were highly associated with PV gaps using the 90 W/4 s‐vHPSD ablation.