High-power short-duration radiofrequency ablation for atrial fibrillation: There is still a country for “old men”

Table 1 Trials and key evidence

Ref.	Design/population	Strategy/protocol	Key endpoints	Main findings (high level)
QDOT-FAST, 2019[6]	Prospective multicenter single-arm; PAF	vHPSD temperature-controlled (90 W/4 seconds algorithm)	Feasibility, acute performance, safety	Demonstrated feasibility and safety of 90 W/4 seconds temperature-controlled lesions; procedural efficiency vs historical controls
POWER PLUS, 2023[12]	Multicenter RCT; AF undergoing first PVI	Contiguous vHPSD 90 W/4 seconds vs conventional approach	Efficiency; 6-month efficacy; safety	Modest but significant reduction in procedure time; similar safety and 6-month efficacy; suggested hybrid approach may be optimal
SHORT-AF, 2023[10]	RCT; AF ablation with PVI	HPSD vs standard power-standard duration	Time to PVI; 12-month freedom from AF; ACE	Shorter time to PVI; higher freedom from AF at 12 months; trend toward increased ACE
POWER-FAST III, 2025[11]	RCT; PVI with endoscopic assessment	HPSD-70 (70 W, short) vs conventional 25-40 W	Arrhythmia recurrence (noninferiority); endoscopic esophageal lesions	Noninferior for recurrences; similar esophageal lesion incidence; reported symptomatic embolic events in HPSD-70 arm (technology/protocol-dependent signal)
QDOT-by-LAWT, 2024[3]	RCT noninferiority; first-time PAF	LA wall thickness-guided (vHPSD in thinner regions; standard/AI-guided in thicker) vs CLOSE	12-month effectiveness; efficiency	Noninferior 12-month outcomes; marked reductions in RF/procedure times; supports personalization for thicker regions
Sousa et al[9], 2023	RCT; PAF treated with AI	HPSD vs standard LPLD (AI-guided)	Noninferiority; efficiency	Reported noninferiority and faster procedures with shorter ablation times (protocol- and catheter-specific)

RCT: Randomized controlled trial; AF: Atrial fibrillation; PVI: Pulmonary vein isolation; vHPSD: Very high-power short-duration; HPSD: High-power short-duration; ACE: Atrial conduction enhancement; LA: Left atrium; AI: Ablation index; LPLD: Low-power long-duration.