{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T03:33:51Z","timestamp":1790480031547,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T00:00:00Z","timestamp":1730851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Very high\u2010power short\u2010duration (vHPSD) ablation creates shallower lesions, potentially reducing efficacy. This study aims to identify factors leading to insufficient lesions during pulmonary vein antral isolation (PVAI) with vHPSD\u2010ablation and to develop an optimized PVAI strategy using this technology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>PVAI was performed on 41 atrial fibrillation patients using vHPSD\u2010ablation (90\u2009W\/4\u2009s). Lesion parameters were recorded and analyzed to identify predictors of insufficient lesions. An optimized PVAI strategy, based on these predictors, was tested in subsequent 42 patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In total, 3099 RF\u2010applications, including 103(3.3%) insufficient lesions, were analyzed. First\u2010pass PVAI was achieved in 19\/40(47.5%) right PVs and 24\/41(58.5%) left PVs. Multivariate analysis identified significant predictors of insufficient lesions: local largest bipolar voltage (Bi\u2010V), average contact force, baseline impedance, impedance drop, temperature rise, inter\u2010lesion distance (ILD), and anatomical location (carina or not). An ILD:4\u20106\u2009mm increased the risk of insufficient lesions 2.2\u2010fold, and lesions at the carina increased it 3.6\u2010fold for both ILD\u2009&lt;\u20094\u2009mm and ILD:4\u20106\u2009mm. Local largest Bi\u2010V was the strongest predictor for insufficient lesions. The optimized PVAI approach, utilizing vHPSD\u2010ablation with an ILD\u2009&lt;\u20094\u2009mm in non\u2010carinal areas with Bi\u2010V\u2009&lt;\u20094\u2009mV, and high\u2010power ablation\u2010index guided ablation (HPAI, 50\u2009W, ablation\u2010index:450\u2013550) in remaining areas, achieved first\u2010pass PVAI in 92.7% of right PVs and 88.1% of left PVs, using vHPSD\u2010ablation in approximately 65% of total RF\u2010applications. The optimized PVAI achieved significantly higher first\u2010pass PVI rate (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.0001) with shorter ablation time (<jats:italic>p<\/jats:italic>\u2009=\u2009.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Appropriate use of vHPSD and HPAI, based on local largest Bi\u2010V and anatomical information, may achieve high first\u2010pass PVAI rates in shorter ablation time with minimal energy delivery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jce.16453","type":"journal-article","created":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T12:03:41Z","timestamp":1730894621000},"page":"111-123","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Significance of the local largest bipolar voltage for the optimized ablation strategy using very high\u2010power short duration mode"],"prefix":"10.1111","volume":"36","author":[{"given":"Masateru","family":"Takigawa","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Tokyo Medical and Dental University Hospital 1\u20105\u201045 Yushima Bunkyo\u2010ku 113\u20108510 Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0230-0934","authenticated-orcid":false,"given":"Shinsuke","family":"Miyazaki","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tokyo Medical and Dental University Hospital 1\u20105\u201045 Yushima Bunkyo\u2010ku 113\u20108510 Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tasuku","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Tokyo Medical and Dental University Hospital 1\u20105\u201045 Yushima Bunkyo\u2010ku 113\u20108510 Tokyo 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