Comparison between High-Power Short-Duration and Conventional Ablation Strategy in Atrial Fibrillation: An Updated Meta-Analysis

Abstract

High-power short-duration (HPSD) setting during radiofrequency ablation has become an attempt to improve atrial fibrillation (AF) treatment outcomes. This study ought to compare the efficacy, safety, and effectiveness between HPSD and conventional settings. PubMed, Embase, and Cochrane Library were searched. Studies that compared HPSD and conventional radiofrequency ablation settings in AF patients were included while studies performed additional ablations on nonpulmonary vein targets without clear recording were excluded. Data were pooled with random-effect model. Efficacy endpoints include first-pass pulmonary vein isolation (PVI), acute pulmonary vein (PV) reconnection, free from AF, and free from atrial tachycardia (AT) during follow-up. Safety endpoints include esophagus injury rate and major complication rate. Effectiveness endpoints include complete PVI rate, total procedure time, PVI time, and PVI radiofrequency ablation (PVI RF) time. We included 22 studies with 3867 atrial fibrillation patients in total (2393 patients received HPSD radiofrequency ablation). Perioperatively, the HPSD group showed a higher first-pass PVI rate (risk ratio, RR = 1.10 , P = 0.0001 ) and less acute PV reconnection rate ( RR = 0.56 , P = 0.0004 ) than the conventional group. During follow-up, free from AF ( RR = 1.11 , P = 0.16 ) or AT ( RR = 1.06 , P = 0.24 ) rate did not differ between HPSD and conventional groups 6-month postsurgery. However, the HPSD group showed both higher free from AF ( RR = 1.17 , P = 0.0003 ) and AT ( RR = 1.11 , P < 0.0001 ) rate than the conventional group 12-month postsurgery. The esophagus injury ( RR = 0.99 , P = 0.98 ) and major complications ( RR = 0.76 , P = 0.70 ) rates did not differ between the two groups. The HPSD group took shorter total procedure time ( MD = − 33.71 95% CI: -43.10 to -24.33, P < 0.00001 ), PVI time ( MD = − 21.60 95% CI: -25.00 to -18.21, P < 0.00001 ), and PVI RF time ( MD = − 13.72 , 95% CI: -14.45 to -13.00, P < 0.00001 ) than conventional groups while complete procedure rate did not differ between two groups ( RR = 1.00 , P = 0.93 ). HPSD setting during AF radiofrequency ablation has better effectiveness, efficacy, and similar safety compared with the conventional setting.

Predictors of first pass isolation of the pulmonary veins in real world ablations: An analysis of 2671 patients from the REAL‐AF registry

“…In our study, the use of higher power was related to improved FPI rates. This finding is consistent with a recent meta‐analysis of 22 studies showing improved FPI and 12‐month arrhythmia free survival with high power short duration ablation 10,11 . Beyond power settings, we found ablation CF and surpoint index targets to be most influential posteriorly.…”

Comparison of lesion characteristics using temperature‐flow‐controlled versus conventional power‐controlled ablation with fixed ablation index

“…Fourth, Ablation Index was not originally designed for high power applications with longer durations, and ablation at 50 W targeting an AI of 550 may increase a risk of steam pop. However, this study focused on analyzing the effect of TFC‐ablation on lesion metrics and did not validate the efficacy and safety of high‐power short duration ablation, which has been already reported in several studies 28 …”

“…However, this study focused on analyzing the effect of TFC-ablation on lesion metrics and did not validate the efficacy and safety of high-power short duration ablation, which has been already reported in several studies. 28…”

Efficiency and safety of high‐power ablation guided by Lesion size index: An ex vivo porcine heart study

“…However, the pulmonary vein reconduction rate remains high. Currently, high‐power RF ablation has become an attempt to improve AF treatment outcomes 6 . The quantification of RF thermal injury at high power settings remains to be determined.…”