Introduction <p>A hybrid approach with very high-power short-duration (vHPSD) posteriorly and ablation-index guided HPSD (50 W) anteriorly seems to be an optimal balance between efficiency and effectiveness for point-by-point pulmonary vein isolation (PVI). The aim of the current study is to compare vHPSD/HPSD ablation to cryoballoon ablation (CBA) in patients with symptomatic atrial fibrillation (AF).</p> Methods and results <p>In this retrospective single-center study, we identified 110 consecutive patients who underwent their first PVI with either vHPSD/HPSD (<i>n</i> = 54) or CBA (<i>n</i> = 56). We compared procedural efficacy, efficiency, safety, and long-term outcomes. Baseline characteristics of both groups were comparable; however, patients in the vHPSD/HPSD group had larger left atrial volume index (35, IQR 27–45 vs. 28, IQR 21–36&#xa0;ml/m², <i>P</i> = 0.005). Complete PVI was achieved in all patients except two CBA cases (100% vs. 96.4%, <i>P</i> = 0.50). First-pass isolation rate was 79.6% in the hybrid group. Procedure times were similar between groups (53, IQR 47–63 vs. 55, IQR 49–65&#xa0;min, <i>P</i> = 0.35), but fluoroscopy time was shorter in the vHPSD/HPSD group (3.9 [2.7, 5.6] vs. 11.9 [9.3, 14.9] min, <i>P</i> &lt; 0.001). There were 3 temporary phrenic nerve palsies (5.4%) in the CBA group which resolved within 1&#xa0;year. The 1-year freedom from any atrial tachyarrhythmias after a single procedure was similar between groups (68.5% vs. 73.2%, <i>P</i> = 0.56). During repeat procedure, the durability of PVI was comparable.</p> Conclusions <p>The use of vHPSD/HPSD ablation renders point-by-point PVI as fast and effective as CBA. Furthermore, it has lower radiation exposure compared to CBA.</p> Graphical abstract <p></p>