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

Winkle, Roger A.

doi:10.1111/jce.14863

Cited by 39 publications

(50 citation statements)

References 36 publications

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“…to the review paper, 2 but their results are in line with all the other studies and would not have changed the conclusions of the review. I hope Dr Ejima and colleagues can appreciate the circumstances under which this review paper was prepared.…”

supporting

confidence: 64%

Response to letter to the editor

Winkle

2022

Cardiovasc electrophysiol

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I appreciate Dr Koichiro Ejima and colleagues pointing out my oversight in not including their second excellent article comparing high-power short-duration with low-power long-duration ablation. 1 I am not certain whether their letter to the editor is intended to self-promote their own publication or to chastise me for not including it, or both. Whatever the motivation, they have my sincere apologies. I concur it would have been a nice addition

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confidence: 64%

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Winkle

2022

Cardiovasc electrophysiol

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“…Optimized use of conventional radiofrequency ablation has the potential to improve safety and efficacy of PWI. High power (45–50 W) short duration (5–10 s) ablation (in power‐controlled mode), which produces wider and shallower lesions compared to conventional radiofrequency application approaches, appears to have an overall excellent safety profile 50 . Given the LAPW is a thin walled structure, high power short duration ablation may be particularly well suited for effecting shallow but transmural lesions that reduce the risk for esophageal damage 51 …”

Section: Emerging Approaches To Energy Deliver To Improve Safety and Efficacy Of Pwimentioning

confidence: 99%

The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation

Clarke

Piccini

Friedman

2021

Cardiovasc electrophysiol

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The left atrial posterior wall has many embryologic, anatomic, and electrophysiologic characteristics, that are important for the initiation and maintenance of persistent atrial fibrillation. The left atrial posterior wall is a potential target for ablation in patients with persistent atrial fibrillation, a population in whom pulmonary vein isolation alone has resulted in unsatisfactory recurrence rates. Published clinical studies report conflicting results on the safety and efficacy of posterior wall isolation. Emerging technologies including optimized use of radiofrequency ablation, pulse field ablation, and combined endocardial/epicardial ablation may optimize approaches to posterior wall isolation and reduce the risk of injury to nearby structures such as the esophagus. Critical evaluation of future and ongoing clinical studies of posterior wall isolation requires careful scrutiny of many characteristics, including intraprocedural definition of posterior wall isolation, concomitant extrapulmonary vein ablation, and study endpoints.

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“…Although randomized studies comparing the two ablation strategies are lacking, comprehensive prospective and retrospective nonrandomized data on HPSD ablation have been published (8). In this study, our aim was to determine the pooled incidence of atrial arrhythmia recurrence after HPSD ablation and to compare it with results of LPLD ablation.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation

Khanra¹,

Hamid²,

Deshpande³

et al. 2022

The Anatolian Journal of Cardiology

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Objective: High power short duration (HPSD) ablation strategy is proposed to be more effective than low power long duration (LPLD) for radiofrequency ablation of atrial fibrillation. Although small trials abound, data from a large cohort are lacking. This meta-analysis compares all the existing studies comparing these two approaches to evaluate perceived advantages of one over the other. Methods: A systematic search of PubMed, EMBASE, and Cochrane databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model. Results: Ablation settings varied widely across 20 studies comprising 2,136 patients who underwent HPSD and 1,753 patients who underwent LPLD. The pooled incidence of atrial arrhythmia recurrence after HPSD ablation was 20% [95% confidence interval (CI): 0.16-0.25; I 2 =88%]. Atrial arrhythmia recurrences were significantly less frequent with HPSD ablation (incidence risk ratio=0.66; 95% CI: 0.49-0.88; I 2 =72%; p=0.004). Procedural, fluoroscopy, and ablation times were significantly shorter with HPSD ablation. First-pass pulmonary vein isolations (PVIs) were significantly more [odds ratio (OR)=2.94; 95% CI: 1.50-5.77; I 2 =89%; p=0.002), and acute pulmonary vein reconnections (PVRs) were significantly lesser (OR=0.41; 95% CI: 0.28-0.62; I 2 =62%; p<0.001) in the HPSD group. Although radiofrequency energy was significantly higher, esophageal thermal injuries (ETI) were lower with HPSD ablation. Acute complications, including steam-pops, were rare and statistically similar in both the groups. Conclusion: HPSD ablation enables faster first-pass PVI with fewer PVRs, similar ETI rates, rare collateral damage, and lower recurrence of atrial arrhythmia in the long term than LPLD. Randomized controlled studies with a larger cohort are indicated both to confirm the benefit of HPSD ablation and standardize the ablation protocol.

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

Cited by 39 publications

References 36 publications

Response to letter to the editor

Response to letter to the editor

The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation

Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation

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