Preliminary results of the POWER FAST III trial showed that high-power, short-duration radiofrequency (HPSD RF) pulmonary vein isolation (PVI) was non-inferior to low-power, long-duration (LPLD) RF PVI regarding arrhythmia recurrence rates in patients with atrial fibrillation (AF).

In 301 patients with AF, the POWER FAST III trial compared the esophageal safety and efficacy of an HPSD RF application for PVI (70 W for 9-10 s) with an LPLD RF procedure (25-40 W guided by ablation lesion indexes). The patients were randomized 1:1 to one of two study groups. The preliminary findings were presented by Sergio Castrejón, PhD, at the 2023 European Heart Rhythm Association (EHRA) in Barcelona, Spain¹.

The rate of first pass PVI was significantly lower in the experimental arm compared with the control arm (70.8% vs 82.8%; P=0.022), a result that was mainly driven by left PV interventions. Although RF to final PVI time was shorter in the high-power arm, the total procedural time was similar for the two study arms. The freedom from arrhythmia recurrences rate did not significantly differ between the high-power and the low-power arm (69.9% vs 75.0%; Plogrank=0.43). Furthermore, the incidence of esophageal thermal lesions was low and not significantly different when comparing the high-power (3.6%) to the low-power arm (2.7%; P=0.68).

Dr. Castrejón added that the complication rate was similar for the two arms of the study (5.6% vs 4.6%; P=0.72) but that the rate of stroke/TIA/systemic embolism was higher in the experimental arm (2.8% vs 0.0%; P=0.04). “This finding raises concerns and warrants further investigation,” he said.

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