CEREBRAL SAFETY AND LESION EFFICACY OF RADIOFREQUENCY ABLATION OF ATRIAL FIBRILLATION
Boga Márton
Cardiovascular Medicine and Research Division
Dr. Merkely Béla
SE Neurológiai Klinika előadóterme
2026-01-20 10:00:00
Cardiovascular Disorders: Physiology and Medicine of Ischaemic Circulatory Diseases
Dr. Merkely Béla
Dr. Szegedi Nándor
Dr. Kardos Attila
Dr. Kupó Péter
Dr. Benyó Zoltán
Dr. Nagy-Baló Edina
Dr. Lintner Balázs
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with increased morbidity, mortality, and reduced quality of life. Pulmonary vein isolation (PVI) is the most effective treatment for AF, with point-by-point radiofrequency (RF) ablation being one of the most widely used techniques. Our research aimed at studying efficacy and safety aspects of modern RF PVI, with special focus on very high-power short-duration (vHPSD) ablation.
Our investigations identified high generator impedance and deviation from the CLOSE protocol as significant predictors of pulmonary vein reconnection. In our 90W PVI cohort –the largest reported to date– vHPSD ablation showed promising mid-term efficacy and a favorable cerebral safety profile, contrasting with previous studies. Importantly, lower baseline generator impedance and transient loss of catheter-to-tissue contact during ablation were linked to the occurrence of silent cerebral events, suggesting possible avenues for minimizing cerebral risks. These studies are the first to highlight the pivotal role of generator impedance in RF ablation in a clinical setting. We propose an optimal generator impedance range from 110Ω to 130Ω in which radiofrequency PVI can be performed safely and effectively. We demonstrated that achieving durable isolation with vHPSD requires smaller interlesion distances (ILDs) than those used in conventional lower-power ablation which is another novel finding. Finally we also showed that given the fixed application time in vHPSD ablation, using reduced ILDs for anterior wall lesions appears necessary in comparison to posterior applications.
Together, these findings may contribute to improving both the safety and efficacy of RF ablation strategies, and thus lead to better outcomes for the large number of patients suffering from AF.
