Safety and Efficacy of High Power Shorter duration Ablation for Atrial
Fibrillation: A Systematic Review and Meta-Analysis.
Abstract
Background: Radiofrequency ablation in patients with atrial fibrillation
(AF) is effective but hampered by pulmonary veins reconnection due to
insufficient lesions. High power shorter duration ablation (HPSD) seen
to increase efficacy and safety. This analysis aimed to evaluate the
clinical benefits of HPSD in patients with AF. Methods: The Medline,
PubMed, Embase, and the Cochrane Library databases were searched for
studies comparing HPSD and Low power longer duration (LPLD) ablation.
Results: A total of seven trials with 2023 patients were included in the
analysis. Pooled analyses demonstrated that HPSD showed a benefit of
first-pass pulmonary vein isolation (PVI) [risk ratio (RR): 1.27; 95%
confidence interval (CI): 1.18–1.37, P < 0.001]. HPSD could
reduce recurrence of atrial arrhythmias (RR: 0.70; 95% CI: 0.50–0.98,
P = 0.04). Additionally, HPSD was more beneficial in terms of procedural
time [Weighted Mean Difference, (WMD): −44.62; 95% CI, −63.00 to
−26.23, P < 0.001], ablation time (WMD: −21.25; 95% CI:
−25.36 to −17.13, P < 0.001), and fluoroscopy time (WMD:
−4.13; 95% CI: −7.52 to −0.74, P < 0.001). Moreover, major
complications and esophageal thermal injury (ETI) were similar between
two groups (RR: 0.75; 95% CI: 0.44–1.30, P = 0.31) and (RR: 0.64; 95%
CI: 0.17–2.39, P = 0.51). Conclusion: HPSD was safe and efficient for
treating AF with clear advantages of procedural features, it also showed
benefits of higher first-pass PVI and reducing recurrence of atrial
arrhythmias compared with the LPLA. Moreover, major complications and
ETI were similar between two groups.