High-power short-duration vs. conventional catheter ablation for atrial fibrillation: a meta-analysis and trial sequential analysis of randomized controlled trials

Background High-power short-duration (HPSD) ablation has emerged as an alternative to traditional low-power long-duration (LPLD) ablation. However, the safety and efficacy of HPSD remain controversial. This study aimed to evaluate the effectiveness and safety of HPSD in the ablation treatment of atrial fibrillation (AF). Methods Randomized controlled trials (RCTs) comparing high-power short-duration (HPSD) and low-power long-duration (LPLD) ablation were retrieved from PubMed, Web of Science, EMBASE, and the Cochrane Library up to 20 May 2025. Statistical analysis was performed using RevMan 5.4 software. The risk ratio (RR) was used as the effect size for dichotomous variables, and the mean and standard deviation were used as the effect sizes for continuous variables. Results A total of eight RCTs involving 1,024 patients were included. HPSD was significantly associated with a reduction in total procedure time [mean differences (MD), −20.33; 95% CI: −30.46 to −10.21; P < 0.0001], pulmonary vein isolation time (MD, −22.01; 95% CI: −27.10 to −16.95; P < 0.00001), radiofrequency time (MD, −10.38; 95% CI: −12.47 to −8.29; P < 0.00001), and AF recurrence (RR, 0.51; 95% CI: 0.36–0.74; P = 0.0004, I 2 = 14%, P = 0.32). However, no significant differences were observed between HPSD and LPLD ablation in all atrial arrhythmias recurrence (RR, 1.06; 95% CI: 0.75–1.49; P = 0.74, I 2 = 40%, P = 0.15), the incidence of esophageal lesions (RR, 1.21; 95% CI: 0.55–2.64; P = 0.63), any complications (RR, 1.37; 95% CI: 0.76–2.45; P = 0.29), first-pass left pulmonary vein (LPV) isolation (RR, 0.96; 95% CI: 0.91–1.01; P = 0.10, I 2 = 47%, P = 0.11), and first-pass right pulmonary vein (RPV) isolation (RR, 1.01; 95% CI: 0.69–1.48; P = 0.97, I 2 = 75%, P = 0.003). Conclusion Compared with LPLD ablation, HPSD ablation was significantly associated with a reduction in total procedure time, PVI time, and radiofrequency time. HPSD ablation did not increase the risk of complications compared with LPLD ablation, but it may be underpowered to detect rare adverse events, necessitating additional large-scale RCTs to validate the safety profile of HPSD. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42023471797 , PROSPERO CRD42023471797.