High‐power short duration and low‐power long duration in atrial fibrillation ablation: A meta‐analysis

Kewcharoen, Jakrin; Techorueangwiwat, Chol; Kanitsoraphan, Chanavuth; Leesutipornchai, Thiratest; Akoum, Nazem; Bunch, T. Jared; Navaravong, Leenhapong

doi:10.1111/jce.14806

Cited by 42 publications

(33 citation statements)

References 47 publications

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“…Fifth, despite the propensity-matched comparison, there was an evolution of the mapping system, and the catheters and the ablation technique do not remain the same during the long-term period of patient inclusion. Sixth, although similar results were reported in the previous studies (39,40), this study reported outcomes including autonomic neural effects of HPSD in the large population cohort with propensity score matching. Finally, this study was an observational study and even propensity score matching could not compensate for all confounding factors such as center experience and advanced ablation technology might affect the outcome of this study.…”

Section: Limitationssupporting

confidence: 72%

Efficacy and Safety of High-Power Short-Duration Radiofrequency Catheter Ablation of Atrial Fibrillation

Park

Yang

Kim

et al. 2021

Front. Cardiovasc. Med.

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Introduction: Whereas, high-power short-duration (HPSD) radiofrequency (RF) ablation is generally used in atrial fibrillation (AF) catheter ablation (CA), its efficacy, safety, and influence on autonomic function have not been well established in a large population. This study compared HPSD-AFCA and conventional power (ConvP)-AFCA in propensity score matched-population.Methods: In 3,045 consecutive patients who underwent AFCA, this study included 1,260 patients (73.9% male, 59 ± 10 years old, 58.2% paroxysmal type) after propensity score matching: 315 in 50~60W HPSD group vs. 945 in the ConvP group. This study investigated the procedural factors, complication rate, rhythm status, and 3-month heart rate variability (HRV) between the two groups and subgroups.Results: Procedure time was considerably short in the HPSD group (135 min in HPSD vs. 181 min in ConvP, p < 0.001) compared to ConvP group, but there was no significant difference in the complication rate (2.9% in HPSD vs. 3.7% in ConvP, p = 0.477) and the 3-month HRV between the two groups. At the one-year follow-up, there was no significant difference in rhythm outcomes between the two groups (Overall, Log-rank p = 0.885; anti-arrhythmic drug free, Log-rank p = 0.673). These efficacy and safety outcomes were consistently similar irrespective of the AF type or ablation lesion set. The Cox regression analysis showed that the left atrium volume index estimated by computed tomography (HR 1.01 [1.00–1.02]), p = 0.003) and extra-pulmonary vein triggers (HR 1.59 [1.03–2.44], p = 0.036) were independently associated with one-year clinical recurrence, whereas the HPSD ablation was not (HR 1.03 [0.73–1.44], p = 0.887).Conclusion: HPSD-AFCA notably reduced the procedure time with similar rhythm outcomes, complication rate, and influence on autonomic function as ConvP-AFCA, irrespective of the AF type or ablation lesion set.

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Section: Limitationssupporting

confidence: 72%

Efficacy and Safety of High-Power Short-Duration Radiofrequency Catheter Ablation of Atrial Fibrillation

Park

Yang

Kim

et al. 2021

Front. Cardiovasc. Med.

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“…After optimizing the contact force, there was no steam pops occurred in the following procedures [ 17 ]. One meta-analysis study concluded that the periprocedural risk is similar between conventional energy and HPSD in AF ablation [ 18 ]. Therefore, HPSD is still an effective and safe ablation strategy without increasing the periprocedural risk.…”

Section: Discussionmentioning

confidence: 99%

Comparison of lesion characteristics between conventional and high-power short-duration ablation using contact force-sensing catheter in patients with paroxysmal atrial fibrillation

Chen

Lee

et al. 2021

BMC Cardiovasc Disord

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Background Transmural lesion creation is essential for effective atrial fibrillation (AF) ablation. Lesion characteristics between conventional energy and high-power short-duration (HPSD) setting in contact force-guided (CF) ablation for AF remained unclear. Methods Eighty consecutive AF patients who received CF with conventional energy setting (power control: 25–30 W, force–time integral = 400 g s, n = 40) or with HPSD (power control: 40–50 W, 10 s, n = 40) ablation were analyzed. Of them, 15 patients in each conventional and HPSD group were matched by age and gender respectively for ablation lesions analysis. Type A and B lesions were defined as a lesion with and without significant voltage reduction after ablation, respectively. The anatomical distribution of these lesions and ablation outcomes among the 2 groups were analyzed. Results 1615 and 1724 ablation lesions were analyzed in the conventional and HPSD groups, respectively. HPSD group had a higher proportion of type A lesion compared to conventional group (P < 0.01). In the conventional group, most type A lesions were at the right pulmonary vein (RPV) posterior wall (50.2%) whereas in the HPSD group, most type A lesions were at the RPV anterior wall (44.0%) (P = 0.04). The procedure time and ablation time were significantly shorter in the HPSD group than that in the conventional group (91.0 ± 12.1 vs. 124 ± 14.2 min, P = 0.03; 30.7 ± 19.2 vs. 57.8 ± 21 min, P = 0.02, respectively). At a mean follow-up period of 11 ± 1.4 months, there were 13 and 7 patients with recurrence in conventional and HPSD group respectively (P = 0.03). Conclusion Optimal ablation lesion characteristics and distribution after conventional and HPSD ablation differed significantly. HPSD ablation had shorter ablation time and lower recurrence rate than did conventional ablation.

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“…Kewcharoen et al 28 found that the more veins that had reconnected after the initial ablation, the better the outcome of the redo ablation. One of the early studies 31 of high-power ablation did not reduce the duration of RF energy application and showed that, when HPSD for long duration is utilized, there are a substantial number of unwanted complications.…”

Section: Meta-analysesmentioning

confidence: 99%

HPSD ablation for AF high‐power short‐duration RF ablation for atrial fibrillation: A review

Winkle

2021

Cardiovasc electrophysiol

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This manuscript reviews the literature for all in silico, ex vivo, in vitro, in vivo and clinical studies of high‐power short‐duration (HPSD) radiofrequency (RF) ablations. It reviews the biophysics of RF energy delivery applicable to HPSD and the use of surrogate endpoints to guide the duration of HPSD ablations. In silico modeling shows that a variety of settings in power, contact force and RF duration can result in the same surrogate endpoint value of ablation index and several HPSD combinations produce lesion volumes similar to a low‐power long‐duration (LPLD) RF application. HPSD lesions are broader with more endocardial effect and are slightly shallower but still transmural. The first 10 s of RF application is most important for lesion formation with diminishing effect beyond 20 s. The ideal contact force is 10–20 g with only a small effect beyond 30 g. In vitro and in vivo models confirm that HPSD makes transmural lesions that are often broader and shallower, and with proper settings, result in fewer steam pops than LPLD. One randomized trial shows better outcomes with HPSD and validates lesion size index as a surrogate endpoint. Clinical studies of HPSD using comparator groups of LPLD ablations uniformly show shorter procedure times and shorter total RF energy delivery for HPSD. HPSD generally has a higher first pass vein isolation rate and a lower acute vein reconnection rate than LPLD. Although not dramatically different from LPLD, long‐term freedom from atrial fibrillation and complication rates seem slightly better with HPSD.

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High‐power short duration and low‐power long duration in atrial fibrillation ablation: A meta‐analysis

Cited by 42 publications

References 47 publications

Efficacy and Safety of High-Power Short-Duration Radiofrequency Catheter Ablation of Atrial Fibrillation

Efficacy and Safety of High-Power Short-Duration Radiofrequency Catheter Ablation of Atrial Fibrillation

Comparison of lesion characteristics between conventional and high-power short-duration ablation using contact force-sensing catheter in patients with paroxysmal atrial fibrillation

HPSD ablation for AF high‐power short‐duration RF ablation for atrial fibrillation: A review

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