POWER FAST III: High-power, short-duration radiofrequency ablation for AF

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

The POWER FAST III trial (NCT04153747) compared the oesophageal safety and efficacy of an HPSD radiofrequency application for PVI (70 W for 9–10 s) with an LPLD radiofrequency procedure (25–40 W guided by ablation lesion indexes) in 301 patients with AF [1]. The participants were randomised 1:1 to 1 of the 2 procedures. The preliminary findings were presented by Dr Sergio Castrejón (La Paz University Hospital, Spain).

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 radiofrequency to final PVI time was shorter in the high-power arm, the total procedural time was similar for the 2 study arms. Importantly, the ‘freedom from arrhythmia recurrences’ rate did not significantly differ between the high-power and the lower-power arm (69.9% vs 75.0%; P_log-rank=0.43). Furthermore, the incidence of oesophageal 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 commented that the complication rate was similar for the 2 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,” emphasised Dr Castrejón.

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   1. Castrejón S, et al. High RF power for faster and safer PV ablation: The POWER FAST III Trial. Late-Breaking Science Day 1, EHRA 2023, 16–18 April, Barcelona, Spain.

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Posted on 3 May 2023