Background and aims. Very-high-power short-duration (vHPSD) ablation with the QDOT MICRO catheter at 90 W (QMODE) and dual-energy catheters combining radiofrequency and pulsed-field energy are both used for pulmonary vein isolation (PVI), but direct comparative procedural data are scarce. We compared procedural efficiency between QDOT 90 W and dual-energy PVI in propensity-matched patients with paroxysmal atrial fibrillation (AF) undergoing first ablation.
Methods. In a single centre registry, patients undergoing their first PVI for paroxysmal AF with QDOT 90W were included and compared with patients undergoing their first PVI using Dual energy Smarttouch SF catheter regarding procedural data and acute results in a propensity matched analysis0.
Patients were matched 1:1 by nearest-neighbour propensity score on age, sex, CHA2DS2-VASc score and body-mass index (BMI), yielding 22 matched pairs. Continuous variables are presented as median [IQR] and categorical variables as n (%); a two-sided p < 0.05 was considered statistically significant.
Results. Altogether, 22 were treated with QDOT 90W and 42 with the Dual energy catheter. Matched groups were comparable for age, sex and CHA2DS2-VASc; QDOT patients had higher BMI (standardized difference 0.32).
QDOT 90 W showed significantly shorter left-atrial dwell and ablation times, with numerically shorter procedure and mapping times, comparable first-pass isolation and no complications in either group. Fluoroscopy time was numerically higher with QDOT.
Conclusion. In propensity-matched patients with paroxysmal AF undergoing first PVI, QDOT 90 W vHPSD ablation achieved comparable acute efficacy with shorter left-atrial and ablation times than dual-energy ablation, supporting greater procedural efficiency. The residual BMI difference and the small single-centre sample warrant confirmation in larger cohorts.
Table 1. Baseline characteristics of the matched cohort
|
Characteristic
|
QDOT 90 W (n=22)
|
Dual-energy (n=22)
|
SMD
|
|
Age, years , mean ± SD
|
68.1 ± 8.3
|
68.0 ± 8.6
|
0.01
|
|
Male sex , n (%)
|
14 (64%)
|
15 (68%)
|
-0.09
|
|
CHA2DS2-VASc, median [IQR]
|
3.0 [2.0-3.8]
|
3.0 [2.0-3.0]
|
0.14
|
|
BMI, kg/m2, mean ± SD
|
31.1 ± 4.2
|
29.7 ± 4.4
|
0.32
|
AF atrial fibrillation, SMD standardized mean difference, BMI body-mass index.
Table 2. Procedural outcomes
|
Outcome
|
QDOT 90 W
|
Dual-energy
|
p-value
|
|
Procedure time, min
|
80 [70-95]
|
90 [80-100]
|
0.079
|
|
LA dwell time, min
|
49 [44-55]
|
64 [56-75]
|
0.001
|
|
Mapping time, min
|
8.0 [7.0-10.0]
|
10 [7-17]
|
0.085
|
|
Ablation time, min
|
26 [19-32]
|
41 [35-50]
|
0.001
|
|
Fluoroscopy time, min
|
5.2 [3.8-6.9]
|
3.5 [2.7-5.7]
|
0.085
|
|
Dose-area product, cGy·cm2
|
127 [90-214]
|
160 [94-331]
|
0.408
|
|
First-pass isolation (all PV)
|
18 (90%)
|
17/22 (77%)
|
0.414
|
|
Complications (any)
|
0 (0%)
|
0(0%)
|
1.000
|
