Single center experience using a contact force sensing very high power short duration radiofrequency catheter for persistent atrial fibrillation guided with an artificial intelligence based software

Abstract Background/Introduction Recently, the TAILORED-AF randomized clinical trial (NCT04702451) demonstrated superiority of ablating persistent atrial fibrillation (AF) with the targeting of dispersion — identified by an artificial intelligence (AI) software — in addition to PVI vs. a PVI-only strategy. Previously, a contact force–sensing catheter optimized for temperature-controlled, very high-power short-duration (vHPSD) radiofrequency (RF) ablation demonstrated safety and efficacy for AF ablation. Purpose To evaluate the feasibility and procedural efficiency of using a vHPSD catheter for an electrogram-based, artificial intelligence-guided patient-tailored persistent AF ablation approach. Methods We conducted a pilot single-center, non-randomized study of persistent AF patients who underwent a first-time catheter ablation. All patients underwent a TAILORED-AF-like approach consisting of an AI-guided spatiotemporal dispersion ablation in addition to PVI. First, electro-anatomical biatrial mapping was obtained while an AI-guided spatiotemporal dispersion software was employed to highlight dispersion regions in real time. Then, PVI and dispersion ablation were performed with the vHPSD catheter using region-adapted maximal power (posterior wall, 90W and anterior wall, 50W). Procedural characteristics and acute outcomes of a 25-patient cohort (vHPSD cohort) were then compared to a sub-group of patients enrolled in the TAILORED-AF trial who were randomized to dispersion-based ablation with a variety of non-vHPSD ablation catheters (non- vHPSD cohort). Results Of the 25 patients included in the vHPSD cohort (age: 72±8 years; female: 44%; body mass index: 27±5 kg/m²; left ventricular ejection fraction: 50%; cardiomyopathy: 44%; CHADS2-VASc: 2 [1.5-3.0]), 72% had persistent AF and 28% had long-standing persistent AF and no major complication was observed. AF termination occurred in 21/25 patients (84%) in the vHPSD cohort and in 110/170 patients (65%) in the non-vHPSD cohort (p=0.06). Procedure, RF and fluoroscopy times were significantly shorter in the vHPSD vs. in the non-vHPSD TAILORED cohort (127±32 min vs 183±61 min, p<0.001; 23±12 vs 43±17, p<0.001; 4±3 vs 10±10, p<0.001). Conclusion(s) This pilot study demonstrates that the use of a vHPSD catheter is safe and efficient to follow a spatiotemporal dispersion-based ablation procedure. Notably, the use of a vHPSD catheter allows for a significant reduction in TAILORED-AF-like procedure times.