{ "id": "ep94944vm8", "slug": "power-short-duration-ablation", "title": "Power short duration ablation", "updated": "2026-10-15", "topic_path": [ { "id": "life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/topics/life" }, { "id": "life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health" }, { "id": "life.health.clinical", "label": "Clinical assessment and procedures", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical" }, { "id": "life.health.clinical.clinical-surgery", "label": "Surgery and surgical specialties", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-surgery" }, { "id": "life.health.clinical.clinical-surgery.cardiac-and-thoracic-surgery-procedures", "label": "Cardiac and thoracic surgery procedures", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-surgery.cardiac-and-thoracic-surgery-procedures" }, { "id": "life.health.clinical.clinical-surgery.cardiac-and-thoracic-surgery-procedures.cardiac-ablation-procedures", "label": "Cardiac ablation procedures", "api_url": "https://www.edgepedia.org/api/v1/topics/life.health.clinical.clinical-surgery.cardiac-and-thoracic-surgery-procedures.cardiac-ablation-procedures" } ], "geo": [ { "id": "geo.nongeo.t2001.life.health.clinical.clinical-surgery.cardiac-and-thoracic-surgery-procedures", "label": "Non-geographic · 2001 to 2020: Cardiac and thoracic surgery procedures", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t2001.life.health.clinical.clinical-surgery.cardiac-and-thoracic-surgery-procedures", "path": [ { "id": "geo.nongeo", "label": "Non-geographic", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo" }, { "id": "geo.nongeo.t2001", "label": "Non-geographic · 2001 to 2020", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t2001" }, { "id": "geo.nongeo.t2001.life", "label": "Life and health", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t2001.life" }, { "id": "geo.nongeo.t2001.life.health", "label": "Human health and medicine", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t2001.life.health" }, { "id": "geo.nongeo.t2001.life.health.clinical", "label": "Clinical assessment and procedures", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t2001.life.health.clinical" }, { "id": "geo.nongeo.t2001.life.health.clinical.clinical-surgery", "label": "Surgery and surgical specialties", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t2001.life.health.clinical.clinical-surgery" }, { "id": "geo.nongeo.t2001.life.health.clinical.clinical-surgery.cardiac-and-thoracic-surgery-procedures", "label": "Cardiac and thoracic surgery procedures", "api_url": "https://www.edgepedia.org/api/v1/geo/geo.nongeo.t2001.life.health.clinical.clinical-surgery.cardiac-and-thoracic-surgery-procedures" } ] } ], "excerpt": "Power short duration ablation, also called HPSD ablation, is a catheter technique using higher power for shorter applications to isolate pulmonary veins in atrial fibrillation.", "snippet": "Power short duration ablation, also called HPSD ablation, is a catheter technique using higher power for shorter applications to isolate pulmonary veins in atrial fibrillation.", "node": "life.health.clinical.clinical-surgery.cardiac-and-thoracic-surgery-procedures.cardiac-ablation-procedures", "markdown": "# Power short duration ablation\n\nPower short duration (PSD) ablation is a catheter radiofrequency technique for pulmonary vein isolation in atrial fibrillation that delivers higher power than conventional ablation, typically 45–50 W, for very short applications of a few seconds per lesion instead of the conventional 20–35 W for 20–40 s.[1](https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euaa327/6125326) • [2](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1703573/full) The strategy, also called high-power short-duration (HPSD) ablation, aims to shorten procedures while producing effective, transmural (extending through the entire heart-wall thickness) lesions with limited heating of tissue beyond the heart wall. Reviews conclude it can be performed safely with procedural efficacy similar to low-power ablation.[3](https://onlinelibrary.wiley.com/doi/10.1111/pace.14167) Definitions of \"high power\" vary across the literature over roughly 50–90 W; one review defines it as a generator output of 50 W or above.[4](https://www.aerjournal.com/articles/high-power-short-duration-radiofrequency-ablation-treatment-af?language_content_entity=en)\n\n| Key fact | Detail |\n|---|---|\n| Conventional (LPLD) settings | 20–35 W for 20–40 s per lesion[2](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1703573/full) |\n| HPSD settings | Usually 45–50 W for 2–10 s on the posterior wall and 5–15 s at other left atrial sites[1](https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euaa327/6125326) |\n| vHPSD settings | 90 W for 4 s with 8 ml/min irrigation, temperature-controlled[5](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.941434/full) |\n| Time savings vs conventional RF | Meta-analysis of 8 RCTs: procedure time −20.33 min, PVI time −22.01 min, RF time −10.38 min[2](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1703573/full) |\n| Efficacy | AF recurrence reduced with HPSD (RR 0.51, 95% CI 0.36–0.74) in RCT meta-analysis[2](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1703573/full) |\n| Lesion geometry | HPSD lesions wider than conventional RF (mean width 10.9 vs 8.7 mm)[6](https://link.springer.com/article/10.1007/s10840-025-02086-9) |\n\n## How it works\n\nRadiofrequency lesion formation combines resistive heating, which occurs directly in tissue next to the electrode, with conductive heating, which spreads heat passively into deeper tissue over time. Very-high-power short-duration delivery at 90 W for 4 s with an 8 ml/min irrigation rate favors resistive heating while decreasing the role of conductive heating compared with low-power long-duration ablation.[5](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.941434/full) Mathematical modeling indicates that resistive heating alone reaches a depth of only 1–1.5 mm during conventional ablation, so deeper conventional lesions depend on conductive heating; HPSD emphasizes resistive heating and limits conductive heat spread, generally producing wider, shallower lesions.[4](https://www.aerjournal.com/articles/high-power-short-duration-radiofrequency-ablation-treatment-af?language_content_entity=en)\n\nThe practical consequence is a lesion that is wide but shallow. HPSD lesion depth can exceed the average left atrial wall thickness of 1.5–2 mm, ensuring transmurality while reducing the risk of injury to extra-cardiac tissue such as the esophagus, and HPSD generates wider endocardial lesions than low-power long-duration delivery.[2](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1703573/full) MRI-based lesion assessment confirms this geometry: mean lesion width was 10.9 mm for HPSD versus 8.7 mm for conventional RF (p = 0.0083).[6](https://link.springer.com/article/10.1007/s10840-025-02086-9) In beating pig hearts, 90 W/4 s linear ablation and pulmonary vein isolation produced more predictable, contiguous, transmural lesions, while conventional settings produced visible gaps, variable lesion sizes, and non-transmural lesions on histology.[4](https://www.aerjournal.com/articles/high-power-short-duration-radiofrequency-ablation-treatment-af?language_content_entity=en)\n\n## How it is done\n\nThe vHPSD workflow is built around a dedicated catheter and generator. The QDOT MICRO catheter is a contact-force-sensing catheter with microelectrodes and 6 thermocouples for real-time temperature monitoring, developed for temperature-controlled ablation at 90 W for 4 s.[7](https://link.springer.com/article/10.1007/s10840-023-01520-0) • [5](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.941434/full) The nGEN radiofrequency generator delivers up to 100 W with a ramp-up of 0.5 s or less and temperature feedback every 33 ms; the vHPSD algorithm rapidly cycles power based on the hottest surface thermocouple, with a temperature target of 60 °C and cutoff at 65 °C.[7](https://link.springer.com/article/10.1007/s10840-023-01520-0) When an application starts, a 2-second pre-RF delay raises irrigation to 8 ml/min to cool the surface tissue before power ramps to 90 W, and energy is terminated automatically after 4 s.[7](https://link.springer.com/article/10.1007/s10840-023-01520-0)\n\nVeins are encircled point by point, delivering 90 W for 4 s once contact force of at least 5 g is reached, with a target interlesion distance of 4 mm or less on the anterior wall and 6 mm or less on the posterior wall.[7](https://link.springer.com/article/10.1007/s10840-023-01520-0) The QDOT MICRO vHPSD algorithm modulates power to maintain target temperature during 90 W applications lasting 4 s or less.[8](https://pubmed.ncbi.nlm.nih.gov/36752484/) Some operators instead guide lesions with the Ablation Index, an arbitrary unit composed of power, contact force, and ablation time.[9](https://www.mdpi-res.com/d_attachment/jcdd/jcdd-09-00278/article_deploy/jcdd-09-00278.pdf?version=1660815793)\n\n## Origin\n\nTilz and colleagues introduced very high-power short-duration temperature-controlled ablation for pulmonary vein isolation in the fast and furious - AF study, a temperature-controlled vHPSD versus conventional power-controlled comparison published in IJC Heart & Vasculature in 2021.[10](https://doi.org/10.1016/j.ijcha.2021.100847) Over the following years, preclinical and clinical studies confirmed the feasibility, safety, and outcomes of pulmonary vein isolation with HPSD and vHPSD settings.[11](https://onlinelibrary.wiley.com/doi/10.1111/jce.14649)\n\n## Variants\n\nThree named variants appear in the literature. HPSD in the narrower sense uses about 45–50 W for 2–10 s per posterior-wall lesion and 5–15 s elsewhere.[1](https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euaa327/6125326) vHPSD uses 90 W for 4 s with temperature control on the QDOT MICRO catheter.[7](https://link.springer.com/article/10.1007/s10840-023-01520-0) In the completed POWER FAST III trial, HPSD-70 (70 W/9–10 s) was noninferior to conventional 25–40 W ablation for 12-month freedom from atrial arrhythmia recurrence (67% vs 73.5%; HR 1.28, 95% CI 0.82–1.99, P = 0.28), with similar rates of endoscopically detected esophageal thermal lesions (3.6% vs 2.7%, P = 0.94) and shorter RF time, but a numerically higher rate of embolic events (4 vs 0), leading the authors to caution against HPSD-70 as a first-line strategy.[12](https://www.clinicaltrials.gov/ct2/show/NCT04153747) • [13](https://www.springermedizin.de/multicenter-prospective-comparison-of-conventional-and-high-powe/24042306) Techniques also differ in guidance: point-by-point delivery with fixed power and duration versus ablation-index-guided delivery.[9](https://www.mdpi-res.com/d_attachment/jcdd/jcdd-09-00278/article_deploy/jcdd-09-00278.pdf?version=1660815793) A Bayesian network meta-analysis found both HPSD and vHPSD reduced recurrence compared with low-power long-duration ablation (RR 0.85, 95% CrI 0.75–0.96, and RR 0.79, 95% CrI 0.64–0.96), while the vHPSD versus HPSD comparison was inconclusive (RR 0.93).[14](https://pure.eur.nl/en/publications/high-power-very-high-power-and-low-power-radiofrequency-ablation-/)\n\n## Applications\n\nThe main application is pulmonary vein isolation for atrial fibrillation. In the fast and furious - AF study, 56 patients treated with vHP-SD (90 W/4 s) had a median RF ablation time of 338 s (IQR 286–367) versus 1580 s (IQR 1350–1848) in controls, and a median procedure duration of 55 min (IQR 48–60) versus 105 min (IQR 92–120), both p < 0.0001, with all pulmonary veins successfully isolated and no difference in periprocedural complications.[10](https://doi.org/10.1016/j.ijcha.2021.100847) In a cohort of 163 patients (134 paroxysmal, 29 persistent), PVI was achieved in 100% (88% at first pass), acute reconnection was 2%, and 12-month freedom from AF/AT recurrence was 86%, with PVI durability at redo procedures of 78%.[7](https://link.springer.com/article/10.1007/s10840-023-01520-0)\n\nMeta-analyses support these single-arm results. A meta-analysis of 8 randomized trials (1024 patients) found reductions in procedure time (−20.33 min), PVI time (−22.01 min), and RF time (−10.38 min), and lower AF recurrence (RR 0.51, 95% CI 0.36–0.74).[2](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1703573/full) In the Hi-Lo HEAT randomized trial of posterior wall ablation, HPSD reduced RF time (23.8 vs 29.7 min), PVI duration (46.5 vs 59 min), and procedure duration (133 vs 150 min), and after a median 12-month follow-up AF recurrence was lower with HPSD (15.9% vs 34.1%; hazard ratio 0.42, log-rank p = 0.04).[15](https://academic.oup.com/europace/article-pdf/25/2/417/49231247/euac190.pdf)\n\nSafety data are mixed on some endpoints. In the Hi-Lo HEAT trial, esophageal thermal injury occurred in 4.5% of patients (superficial ulcers, n = 4), equally in HPSD and low-power long-duration groups (p = 1.0), and maximal esophageal temperature did not differ (38.6 °C vs 38.7 °C).[15](https://academic.oup.com/europace/article-pdf/25/2/417/49231247/euac190.pdf) In the 163-patient vHPSD cohort, no death, tamponade, or steam pops occurred, though 5 patients had vascular complications.[7](https://link.springer.com/article/10.1007/s10840-023-01520-0) By contrast, in a temperature-controlled 90 W/4 s series with the QDot catheter, steam pops were detected in 24 applications in 18 patients (39.1%) without tamponade, and 4 patients (17.4%) showed silent cerebral lesions on MRI with no thromboembolic complications.[16](https://www.springermedicine.com/atrial-fibrillation/temperature-controlled-high-power-short-duration-ablation-with-9/23203552) The QDOT FAST trial, described as the only clinical trial of very high power at the time, reported one adverse event, a hemorrhage from an esophageal ulcer one day after the procedure, managed medically.[4](https://www.aerjournal.com/articles/high-power-short-duration-radiofrequency-ablation-treatment-af?language_content_entity=en)\n\n## Limitations and alternatives\n\nThe main alternatives are cryoballoon ablation, pulsed field ablation (PFA), and conventional low-power long-duration RF. In an MRI-based head-to-head study of 138 first-time PVI patients, the proportion of complete PV-encircling lesions was highest with HPSD (40%) versus RF (26%), cryoballoon (24%), and PFA (12%) (p = 0.0069), and cumulative gap length was lowest with HPSD (15%) versus ablation-index-guided RF (18%), cryoballoon (19%), and PFA (36%) (p < 0.0001); however, 12-month arrhythmia-free survival did not differ significantly (HPSD 84%, RF 70%, cryoballoon 70%, PFA 80%; log-rank p = 0.451).[6](https://link.springer.com/article/10.1007/s10840-025-02086-9) Comparisons with PFA disagree on recurrence: a meta-analysis of nine studies found PFA associated with lower atrial tachyarrhythmia recurrence than v/HPSD RFA (RR 0.81, p = 0.01), with markedly shorter procedures (−35.97 min) but longer fluoroscopy time (+7.78 min),[17](https://esc365.escardio.org/journal/92778) while the LGE-CMR head-to-head study found comparable arrhythmia-free survival.[6](https://link.springer.com/article/10.1007/s10840-025-02086-9)\n\nSeveral limitations remain. The RCT meta-analysis found no significant differences in all-atrial-arrhythmia recurrence (RR 1.06), esophageal lesions (RR 1.21), any complications (RR 1.37), or first-pass left and right PV isolation, and its authors note that HPSD safety may be underpowered for rare adverse events.[2](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1703573/full) The steam pop rate during temperature-controlled 90 W/4 s ablation differs sharply between published series (39.1% of patients in one[16](https://www.springermedicine.com/atrial-fibrillation/temperature-controlled-high-power-short-duration-ablation-with-9/23203552) versus none in another[7](https://link.springer.com/article/10.1007/s10840-023-01520-0)), an unresolved discrepancy.\n\n## References\n\n1. [High-power short duration vs. conventional radiofrequency ablation of atrial fibrillation: a systematic review and meta-analysis (Europace)](https://academic.oup.com/europace/advance-article/doi/10.1093/europace/euaa327/6125326)\n2. [High-power short-duration vs. conventional catheter ablation for atrial fibrillation: a meta-analysis and trial sequential analysis of randomized controlled trials](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2025.1703573/full)\n3. [High-power short-duration ablation of atrial fibrillation: A contemporary review (Pacing and Clinical Electrophysiology)](https://onlinelibrary.wiley.com/doi/10.1111/pace.14167)\n4. [High-power, Short-duration Radiofrequency Ablation for the Treatment of AF](https://www.aerjournal.com/articles/high-power-short-duration-radiofrequency-ablation-treatment-af?language_content_entity=en)\n5. [Characteristics of Very High-Power, Short-Duration Radiofrequency Applications](https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.941434/full)\n6. [Head-to-head comparison of pulsed-field ablation, high-power short-duration ablation, cryoballoon and conventional radiofrequency ablation by MRI-based ablation lesion assessment](https://link.springer.com/article/10.1007/s10840-025-02086-9)\n7. [One-year outcomes in patients undergoing very high-power short-duration ablation for atrial fibrillation](https://link.springer.com/article/10.1007/s10840-023-01520-0)\n8. [Very High-Power Short-Duration, Temperature-Controlled Radiofrequency Ablation in Paroxysmal Atrial Fibrillation: The Prospective Multicenter Q-FFICIENCY Trial](https://pubmed.ncbi.nlm.nih.gov/36752484/)\n9. [Very High-Power Short-Duration (HPSD) Ablation for Pulmonary Vein Isolation: Short and Long-Term Outcome Data](https://www.mdpi-res.com/d_attachment/jcdd/jcdd-09-00278/article_deploy/jcdd-09-00278.pdf?version=1660815793)\n10. [Roland Richard Tilz and colleagues (2021). Very high-power short-duration temperature-controlled ablation versus conventional power-controlled ablation for pulmonary vein isolation: The fast and furious - AF study. IJC Heart & Vasculature.](https://doi.org/10.1016/j.ijcha.2021.100847)\n11. [Update on high-power short-duration ablation for pulmonary vein isolation (Journal of Cardiovascular Electrophysiology)](https://onlinelibrary.wiley.com/doi/10.1111/jce.14649)\n12. [High Radiofrequency Power for Faster and Safer Pulmonary Vein Ablation Trial (POWER FAST III)](https://www.clinicaltrials.gov/ct2/show/NCT04153747)\n13. [Multicenter prospective comparison of conventional and high-power short duration radiofrequency application for pulmonary vein isolation: the POWER FAST III trial](https://www.springermedizin.de/multicenter-prospective-comparison-of-conventional-and-high-powe/24042306)\n14. [High-power, very-high-power, and low-power radiofrequency ablation for atrial fibrillation: A Bayesian network meta-analysis](https://pure.eur.nl/en/publications/high-power-very-high-power-and-low-power-radiofrequency-ablation-/)\n15. [Hi-Lo HEAT trial: higher power short duration vs. lower power longer duration posterior wall ablation for atrial fibrillation and oesophageal injury outcomes](https://academic.oup.com/europace/article-pdf/25/2/417/49231247/euac190.pdf)\n16. [Temperature-controlled high-power short-duration ablation with 90 W for 4 s: outcome, safety, biophysical characteristics and cranial MRI findings in patients undergoing pulmonary vein isolation](https://www.springermedicine.com/atrial-fibrillation/temperature-controlled-high-power-short-duration-ablation-with-9/23203552)\n17. [Efficacy and safety of Pulsed Field Ablation (PFA) versus Very/High-Power Short Duration Radiofrequency Ablation (v/HPSD RFA) in atrial fibrillation: a systematic review and meta analysis](https://esc365.escardio.org/journal/92778)\n\n---\n*Topic: Encyclopedia › Life and health › Human health and medicine › Clinical assessment and procedures › Surgery and surgical specialties › Cardiac and thoracic surgery procedures › Cardiac ablation procedures*\n\n*Initially written Sep 29, 2026 · Edited: Oct 15, 2026*\n\n*Copyright 2026 EdgeChat AI, a subsidiary of Biostate AI.*\n\nLicense: Edgepedia Community License 1.0, https://www.edgepedia.org/edgepedia/license\n", "same_as": [], "url": "https://www.edgepedia.org/power-short-duration-ablation", "markdown_url": "https://www.edgepedia.org/power-short-duration-ablation.md", "license": { "name": "Edgepedia Community License 1.0", "url": "https://www.edgepedia.org/edgepedia/license", "summary": "Free with credit, commercial use included. AI training is open to everyone. For other uses, organizations over USD 100M in revenue or 100M monthly users license separately.", "spdx": "LicenseRef-Edgepedia-Community-1.0" }, "credit": "\"Power short duration ablation\", Edgepedia (EdgeChat), https://www.edgepedia.org/power-short-duration-ablation. Edgepedia Community License 1.0.", "credit_md": "\"[Power short duration ablation](https://www.edgepedia.org/power-short-duration-ablation)\", Edgepedia (EdgeChat), [https://www.edgepedia.org/power-short-duration-ablation](https://www.edgepedia.org/power-short-duration-ablation). [Edgepedia Community License 1.0](https://www.edgepedia.org/edgepedia/license).", "credit_html": "\"Power short duration ablation\", Edgepedia (EdgeChat), https://www.edgepedia.org/power-short-duration-ablation. Edgepedia Community License 1.0.", "speakable": "Power short duration ablation, also called HPSD ablation, is a catheter technique using higher power for shorter applications to isolate pulmonary veins in atrial fibrillation." }