Porto AG, Zappulla P, Sgarito G, Conti S. High-power short-duration radiofrequency ablation for atrial fibrillation: There is still a country for “old men”. World J Cardiol 2026; 18(7): 120973 [DOI: 10.4330/wjc.120973]
Corresponding Author of This Article
Sergio Conti, MD, PhD, FHRS, FESC, Division of Cardiology, Department of Internal Medicine, Section of Cardiac Electrophysiology, University of Iowa Health Care Center, 200 Hawkins Dr, Iowa City, IA 52242, United States. sergioconti.md@gmail.com
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Cardiac & Cardiovascular Systems
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Porto AG, Zappulla P, Sgarito G, Conti S. High-power short-duration radiofrequency ablation for atrial fibrillation: There is still a country for “old men”. World J Cardiol 2026; 18(7): 120973 [DOI: 10.4330/wjc.120973]
World J Cardiol. Jul 26, 2026; 18(7): 120973 Published online Jul 26, 2026. doi: 10.4330/wjc.120973
High-power short-duration radiofrequency ablation for atrial fibrillation: There is still a country for “old men”
Andrea Giuseppe Porto, Paolo Zappulla, Giuseppe Sgarito, Sergio Conti
Andrea Giuseppe Porto, Division of Cardiology, Cannizzaro Hospital, Catania 95021, Sicilia, Italy
Paolo Zappulla, Division of Cardiology, University Hospital a Policlinico “G. Rodolico-San Marco”, Catania 95123, Sicilia, Italy
Giuseppe Sgarito, Department of Cardiac Electrophysiology, IRCCS ISMETT-UPMC Heart Center, Institute for Transplantation and Advanced Specialized Therapies, Palermo 90127, Italy
Sergio Conti, Division of Cardiology, Department of Internal Medicine, Section of Cardiac Electrophysiology, University of Iowa Health Care Center, Iowa City, IA 52242, United States
Co-first authors: Andrea Giuseppe Porto and Paolo Zappulla.
Author contributions: Porto AG and Sgarito G contributed to conceptualization; Porto AG and Zappulla P contributed to methodology and investigation, writing - original draft preparation, and they contributed equally to this manuscript as co-first authors; Conti S and Sgarito G contributed to writing - review and editing.
AI contribution statement: AI was not used.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Sergio Conti, MD, PhD, FHRS, FESC, Division of Cardiology, Department of Internal Medicine, Section of Cardiac Electrophysiology, University of Iowa Health Care Center, 200 Hawkins Dr, Iowa City, IA 52242, United States. sergioconti.md@gmail.com
Received: March 12, 2026 Revised: June 18, 2026 Accepted: June 30, 2026 Published online: July 26, 2026 Processing time: 127 Days and 18.5 Hours
Core Tip
Core Tip: High-power short-duration (HPSD) is the latest development in radiofrequency (RF) catheter ablation. HPSD has redefined the RF ablation landscape, offering proven advantages over low-power long-duration RF ablation in both safety and efficacy. However, there are still safety issues related to RF thermal effects. In addition, even when following standardized protocols, HPSD RF ablation remains operator-dependent. Pulsed field ablation (PFA) is an innovative, non-thermal ablation technique that employs pulsed electric fields to ablate myocardial tissue selectively, sparing adjacent non-cardiac structures. PFA seems more reproducible, reducing procedural time while maintaining non-inferior efficacy. In the era of PFA, HPSD RF ablation should therefore be viewed not as a technology being replaced, but rather as a mature and efficient strategy that will likely coexist with emerging non-thermal ablation modalities.
