December 7, 2023Arrhythmia & Electrophysiology ReviewOpen Access

Very-high-power Short-duration Ablation versus Conventional Ablation for Pulmonary Vein Isolation in Atrial Fibrillation: Systematic Review and Meta-analysis

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Why the study?

To compare the effectiveness and safety of very-high-power short-duration ablation with conventional ablation for pulmonary vein isolation in patients with AF.

Does very-high-power short-duration ablation reduce AF recurrence in patients with atrial fibrillation compared to conventional ablation?

Structured PICO

Does very-high-power short-duration ablation reduce AF recurrence in patients with atrial fibrillation compared to conventional ablation?

Population

1,527 patients with atrial fibrillation (AF) pooled from 13 studies

Intervention

Very-high-power short-duration (VHPSD) ablation (70-90 W/4-7 s) for pulmonary vein isolation (PVI)

Comparator

Conventional ablation (30-40 W/>20 s, 50 W/7-11 s) for pulmonary vein isolation (PVI)

Outcome

Atrial fibrillation (AF) recurrence

Very-high-power short-duration ablation for pulmonary vein isolation reduces AF recurrence and shortens procedure times compared to conventional ablation, with a similar safety profile.

Implication

May support VHPSD adoption for AF ablation to reduce recurrences; extends evidence via aggregated efficacy and safety data.

Abstract

The aim of this study was to compare the effectiveness and safety of very-high-power short-duration (VHPSD) ablation (70-90 W/4-7 s) with conventional ablation (30-40 W/>20 s, 50 W/7-11 s) for pulmonary vein isolation (PVI) in patients with AF. A total of 13 studies were included in this analysis (1,527 patients). AF recurrence occurred in 14% (95% CI [11-18%]) of the VHPSD group. VHPSD was associated with lower AF recurrence (OR 0.65; 95% CI [0.48-0.89]; p=0.006) compared with the conventional ablation group. Subgroup analysis showed that additional ablation beyond PVI had a similar rate of AF recurrence (16% versus 10%) compared with PVI alone. Procedure and ablation durations were significantly shorter in the VHPSD group with a mean differences of -14.4 minutes (p=0.017) and -14.1 minutes (p<0.001), respectively. Complications occurred in 6% (95% CI [3-9%]) of the VHPSD group, and the rate was similar between the two groups (OR 1.03; 95% CI [0.60-1.80]; p=0.498). VHPSD ablation resulted in less AF recurrence and a shorter procedure time. Additional ablation beyond PVI alone in VHPSD may not provide additional benefits.