**5. Very high-power, short-duration ablation of AF**

The impressive safety and efficacy profile of high-power, short-duration PVI procedures performed with 45–50 W formed a claim to even higher-power ablations with the potential promise of making procedures even shorter while maintaining safety and efficacy. For sure, ablations with very high power should be carried out with caution to avoid the use of high CF values. Appropriate irrigation is also essential to use this technology, which is solved at the recent version of the CoolFlow (Biosense Webster) pump used for 90-W ablations with the QDOT Micro (Biosense Webster) catheter. Because of the very short time of the applications, lesion-predicting parameters such as AI do not work for this type of ablation. Visual tags of the ablated area are located at the spot where the application was started (**Figure 3**).

Long-term results of such clinical trials are likely to be published in the near future. Here, we would like to mention two studies dealing with very high-power, short-duration PVI.

#### **Figure 3.**

*Electroanatomical map of a successful pulmonary vein isolation performed with very high-power, shortduration ablation technique. All ablation tags represent single applications with 90-W power for 4 s.*

*High-Power, Short-Duration Ablation in the Treatment of Atrial Fibrillation Patients DOI: http://dx.doi.org/10.5772/intechopen.100218*

Kottmaier et al. [30] compared PVI procedures performed with 70 W *versus* 30–40 W. Very high-power applications were terminated at 5 and 7 s on the posterior and anterior walls, respectively. HPSD ablation demonstrated a comparable safety profile to conventional ablation. Moreover, HPSD ablation led to significantly fewer arrhythmia recurrences after the one-year, follow-up period. Of course, RF time and procedural time were also significantly shortened by the use of HPSD [30].

A prospective, multicenter, single-arm study was published by Reddy et al. [31], aiming to evaluate the safety and efficacy of very HPSD pulmonary vein isolation with 90 W. All applications were terminated after 4 s. They demonstrated the clinical feasibility and safety of very high-power, short-duration ablation, with very low procedure and fluoroscopy times [31].
