Unipolar electrogram-guided vs. ablation index-guided high-power short-duration pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a single-center randomized controlled trial

Background

Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for paroxysmal atrial fibrillation (PAF). The ablation index (AI) provides an estimate of lesion size and depth, but does not definitively confirm transmurality. Complete elimination of the negative component of the unipolar electrogram (UPE) has been proposed as a marker of transmural lesion formation. High-power short-duration (HPSD) radiofrequency ablation (RFA) produces more homogeneous lesions with clearer boundaries and thus may be more suitable for PVI. This study aimed to assess the AI values achieved during PVI using UPE-guided HPSD RFA and to compare the efficacy and safety of UPE-guided vs. fixed AI-guided HPSD RFA in patients with PAF.