Temperature-controlled Ablation Versus Conventional Ablation for Pulmonary Vein Isolation in the Treatment of AF: A Systematic Review and Meta-Analysis

Background: This study compared the efficacy and safety of temperature-controlled and conventional contact-force-sensing radiofrequency ablation catheters for pulmonary vein isolation (PVI) in AF. Methods: Seven studies (1,138 patients) were included. Randomised controlled trials and observational (single-arm and two-arm) studies that reported freedom from AF ≥3 months after PVI with temperature-controlled radiofrequency ablation catheters (Biosense Webster QDOT MICRO operating in QMODE or Medtronic DiamondTemp) were included. Results: Freedom from AF at a mean (± SD) follow-up of 9.0 ± 3.6 months did not differ significantly between temperature-controlled and conventional ablation (OR 1.22; 95% CI [-0.79, 1.64]; p=0.24). Total procedure duration (-13.5 minutes; 95% CI [-17.1, -10.0 minutes]; p<0.001) and total ablation duration (-8.9 min; 95% CI [-10.3, -7.5 min]; p<0.01) were significantly shorter for temperature-controlled ablation. There were no significant differences between temperature-controlled and conventional ablation in either the aggregated rates of procedural complications (OR 0.69; 95% CI [-0.15, 1.54]; p=0.11) or in the rate of any individual complication. Conclusion: Temperature-controlled ablation was found to be at least non-inferior to conventional ablation in all measures of efficacy and safety. Further randomised controlled trials are warranted to evaluate long-term rates of freedom from AF and patient comfort.