Comparative efficacy and safety profile of high-power short duration
with low power long duration radiofrequency ablation in atrial
fibrillation: An updated systematic review and meta-analysis
Abstract
Background: High power short duration (HPSD) radiofrequency
ablation was expected to be more effective and safer than low power long
duration (LPLD) in treating atrial fibrillation (AF). Given the limited
data, the findings were controversial. This meta-analysis evaluated
whether HPSD’s clinical effects outweigh LPLD’s. Methods: A
systematic search of PubMed, EMBASE, and Google Scholar databases
identified studies comparing HPSD to LPLD ablation. All the analyses
used the random-effects model. Results: This analysis included
21 studies with a total of 4169 patients. Pooled analyses revealed that
HPSD was associated with a lower recurrence of atrial tachyarrhythmias
(ATAs) at one year (RR: 0.62; 95% CI: 0.50 to 0.78, p: 0.00001, I
2: 0%). Furthermore, the HPSD approach reduced the
risk of AF recurrence (RR: 0.64; 95% CI: 0.40 to 1.01, p: 0.06, I
2: 86%), The HPSD approach was associated with a
lower risk of esophageal thermal injury (ETI) (RR: 0.78; 95% CI: 0.58
to 1.04, p: 0.09, I 2: 73%;). The HPSD strategy
increased first-pass pulmonary vein isolation (FPI) and decreased acute
pulmonary vein re-connection (PVR) both of which were predominantly
manifested in bilateral and left pulmonary veins (PVs). HPSD
demonstrated a reduction in procedural time, ablation number for
pulmonary vein isolation (PVI), and fluoroscopy time.
Conclusion: The HPSD method reduces ETI, PV reconnection, and
recurrent AF. The HPSD approach also reduced procedural time, PVI
ablation number, fluoroscopy time, and post-ablation AF relapse in one
year, improving patient outcomes and safety.