Temperature-guided high and very high-power short duration ablation for atrial fibrillation treatment: the peQasus multicentre study

Abstract Aims Temperature-controlled high-power short-duration (HPSD) radiofrequency catheter ablation for pulmonary vein isolation (PVI) utilizing a novel ablation catheter (QDOT Micro) with real-time assessment of catheter tip temperature aims for safer, more effective, and faster procedures. Methods and results The peQasus study is a large European multicentre study set up to assess safety, acute efficacy, and outcomes of temperature-controlled HPSD-based PVI. The primary endpoints were safety, efficacy, and 12-month freedom from atrial tachyarrhythmias. Additionally, two strategies namely very HPSD (90 W for 4 s) only and a hybrid approach (HPSD with maximum of 50 W and vHPSD) were compared. A total of 1023 AF patients in 15 centres from nine European countries received PVI with the QDOT. Complete PVI was successfully achieved in all patients. In 699/1023 (68.3%), the vHPSD-only approach (vHPSD group) and in 324/ (31.7%) patients, the hybrid approach (hybrid group) was utilized. The mean procedure duration was 98.4 ± 37.4 min (vHPSD: 88.2 ± 34.9 min, hybrid: 117.4 ± 32.7 min, P < 0.001). The first-pass isolation rate of all PVs was 64% (vHPSD: 62.6%, hybrid: 67.1%, P = 0.187). Severe adverse events were observed in 1.7% (vHPSD: 1.6%, hybrid: 1.9%, P = 0.746). Twelve-month arrhythmia-recurrence-free survival was 77.1% (vHPSD: 76.8%, hybrid: 77.8%, P = 0.241). Conclusion In this large multicentre study, temperature-controlled HPSD and vHPSD ablation via a novel ablation catheter provides safe and effective PVI with a relatively short procedure duration. Despite a shorter procedure time, no differences in terms of safety and freedom from arrhythmia recurrence were found irrespective of utilizing vHPSD or the hybrid approach.