Prospective Multicenter Registry to Investigate the Clinical Feasibility of Combination Workflow With 90 W/4 s and Ablation Index-Guided 50 W Ablation (PRECISE—COMBO 90 W/50 W Study)

Background: High-power short-duration (HPSD) ablation is an established therapy for pulmonary vein (PV) isolation (PVI) in atrial fibrillation (AF), aiming to form efficient transmural lesions. Very HPSD (vHPSD) can further shorten ablation time but may increase the risk of acute PVI failure compared with HPSD. A combined HPSD and vHPSD strategy (90 W/50 W combination workflow) potentially balances efficiency and durability, though its clinical feasibility remains unknown. Therefore, this multicenter registry evaluated the acute and long-term efficacy of a 90 W/50 W combination workflow for PVI in patients with paroxysmal AF. Methods: In this prospective study, a total of 101 consecutive patients with paroxysmal AF underwent PVI using radiofrequency ablation with a 90 W/50 W combination workflow. We evaluated acute outcomes, including first-pass isolation and acute PV reconnection, and monitored atrial tachyarrhythmia recurrences over 12 months. Results: Median PVI procedure time was 35 min, with total procedure time at 105 min. First-pass PVI was achieved in 58.4% of patients, including 74.3% in the right PV and 72.3% in the left PV. Acute PV reconnection occurred in 31.7% (32/101). In multivariate analysis, carina sites independently predicted acute PVI failure in both HPSD and vHPSD groups, while contact force also predicted failure in the HPSD group. After 1 year, 89.9% of patients remained free from documented atrial tachyarrhythmias. Conclusion: The 90 W/50 W combination workflow did not notably shorten procedure time or enhance first-pass success. More standardized strategies, particularly in carina segments with higher contact force and ablation index under HPSD, may be required to ensure optimal lesion durability and favorable outcomes.