Pulmonary vein isolation using a higher power shorter duration CLOSE protocol with a surround flow ablation catheter

Introduction The CLOSE protocol combines ablation index (AI) and <= 6 mm interlesion distance using standard power settings for the treatment of atrial fibrillation (AF). The purpose was to compare the safety and efficacy of a conventional CLOSE and a higher power shorter duration (HPSD)-CLOSE pulmonary vein isolation (PVI) strategy. Methods and Results All consecutive patients referred for PVI were included after informed consent was obtained from them. Group 1 was treated with a standard CLOSE protocol and group 2 with a HPSD-CLOSE protocol (45 W anterior and 35 W posterior). Procedural parameters and 6-month follow-up were analyzed. In total, 174 patients (group 1: n = 94 [paroxysmal: n = 74]; group 2: n = 80 [paroxysmal: n = 65], similar baseline characteristics) were included. PVI was reached in all, but procedure duration (82 +/- 18 minutes vs 100 +/- 22 minutes; P < .0001) and radiofrequency (RF) time (23 +/- 5 minutes vs 36 +/- 11 minutes; P < .0001) was shorter in group 2. First pass isolation was similar in groups 2 and 1 (left veins: 94% vs 90%; P = .42 and right veins: 83% vs 84%; P = .79, respectively). Six-month off- antiarrhythmic drugs freedom of AF/AT was similar in groups 2 and 1 (82% [paroxysmal: 86%] vs 83% [paroxysmal: 88%]; P = .93, respectively). Major complications were similar (group 2: 1% vs group 1: 3%; P = .39). Conclusion A higher-power short duration approach can shorten a CLOSE procedure and reduce ablation time without having a negative impact on safety or efficiency.