High-power short duration vs. conventional radiofrequency ablation of atrial fibrillation: a systematic review and meta-analysis

Abstract

Aims We sought to compare the effectiveness and safety of high-power short-duration (HPSD) radiofrequency ablation (RFA) with conventional RFA in patients with atrial fibrillation (AF). Methods and results MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 15 May 2020 for relevant studies comparing HPSD vs. conventional RFA in patients undergoing initial catheter ablation for AF. A total of 15 studies involving 3718 adult patients were included in our meta-analysis (2357 in HPSD RFA and 1361 in conventional RFA). Freedom from atrial arrhythmia was higher in HPSD RFA when compared with conventional RFA [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.10–1.90; P = 0.009]. Acute PV reconnection was lower (OR 0.56, P = 0.005) and first-pass isolation was higher (OR 3.58, P < 0.001) with HPSD RFA. There was no difference in total complications between the two groups (P = 0.19). Total procedure duration [mean difference (MD) −37.35 min, P < 0.001], fluoroscopy duration (MD −5.23 min, P = 0.001), and RF ablation time (MD −16.26 min, P < 0.001) were all significantly lower in HPSD RFA. High-power short-duration RFA also demonstrated higher freedom from atrial arrhythmia in the subgroup analysis of patients with paroxysmal AF (OR 1.80, 95% CI 1.29–2.50; P < 0.001), studies with ≥50 W protocol in the HPSD RFA group (OR 1.53, 95% CI 1.08–2.18; P = 0.02] and studies with contact force sensing catheter use (OR 1.65, 95% CI 1.21–2.25; P = 0.002). Conclusion High-power short-duration RFA was associated with better procedural effectiveness when compared with conventional RFA with comparable safety and shorter procedural duration.

The superiority of high‐power short‐duration radiofrequency catheter ablation strategy for atrial fibrillation treatment: A systematic review and meta‐analysis study

“…For the short‐term efficacy outcomes, our study revealed that HPSD RFCA had better first‐pass PVI than LPLD RFCA. This result was consistent with the findings from the previous meta‐analysis 46‐48 . Moreover, the HPSD approach was also associated with a lower risk of PV reconnection.…”

“…Moreover, the HPSD approach was also associated with a lower risk of PV reconnection. The data about the risk of PV reconnection were provided by the meta‐analysis study from Ravi et al 48 and our results supported that. For the long‐term efficacy outcomes, our study demonstrated that performing HPSD RFCA effectively reduced the risk of recurrent AF.…”

“…As we expected, the HPSD ablation strategy effectively reduced the procedural time, fluoroscopy time, and ablation time. It was supported the results from prior meta‐analysis studies 12,46‐48 …”

“…However, the HPSD method failed to reduce the risk of recurrent AFL or AT. The data about recurrent AF and recurrent AFL or AT were not reported in prior meta‐analysis studies, 12,46‐48 and our meta‐analysis study provided data about that. Those prior meta‐analysis studies used freedom from atrial tachyarrhythmias as the efficacy endpoint 12,46‐48 …”

High-power short-duration ablation: The new standard for pulmonary vein isolation?

“…Several prospective randomized and non-randomized studies comparing LP-LD versus HP-SD show that HP-SD is associated with higher first-pass PV isolation and significantly shorter procedural, ablation and fluoroscopy times compared with LP-LD [5] , [6] , [7] , [8] , [9] , [10] . Meta-analysis data demonstrate that HP-SD was associated with better procedural effectiveness when compared with conventional LP-LD ablation with comparable low rate of complications and esophageal thermal injury and shorter procedural duration [11] , [12] .…”