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.

Background: Pulmonary veins reconnection due to insufficient lesions is an important cause of recurrence of atrial fibrillation (AF). High power ablation (HPA) with shorter duration or guided by Ablation index (AI) seen to increase efficacy and safety. This analysis aimed to evaluate the clinical benefits of HPA in patients with AF. Methods: The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPA and conventional power ablation (CPA). Results: A total of nine trials with 2297 patients were included in the analysis. Pooled analyses demonstrated that HPA showed a benefit of first-pass pulmonary vein isolation (PVI) and acute PVs reconnection [risk ratio (RR): 1.27; 95% confidence interval (CI): 1.18–1.37, P < 0.001] and (RR: 0.52; 95% CI: 0.30–0.88, P = 0.01). HPA could reduce recurrence of atrial arrhythmias (RR: 0.71; 95% CI: 0.53–0.97, P = 0.03). Additionally, HPA was more beneficial in terms of procedural time [Weighted Mean Difference, (WMD): −41.19; 95% CI, −56.01 to −26.36, P < 0.001], ablation time (WMD: −19.45; 95% CI: −23.11 to −15.78, P < 0.001), and fluoroscopy time (WMD: −3.10; 95% CI: −5.52 to −0.68, P < 0.001) compared with the CPA approach. Moreover, HPA was associated with low complications (RR: 0.60; 95% CI: 0.36–0.99, P = 0.05). Conclusion: The HPA was a safe and effective approach for treating AF with clear advantages of procedural features. It was also associated with higher first-pass PVI, fewer acute PVs reconnection, recurrence of atrial arrhythmias and complications compared with the CPA approach.