Key result
High-power short-duration ablation increases odds of 1-year atrial arrhythmia freedom ~93% versus conventional ablation.
Why the study?
The authors aimed to further evaluate the comparative effectiveness and safety of high-power short-duration versus conventional radiofrequency ablation in patients with atrial fibrillation.
Does high-power short-duration radiofrequency ablation improve effectiveness and safety compared to conventional radiofrequency ablation in patients with atrial fibrillation?
Meta-Analysis (n=4,934)
Does high-power short-duration radiofrequency ablation improve effectiveness and safety compared to conventional radiofrequency ablation in patients with atrial fibrillation?
Effect estimate: OR 1.93 (95% CI 1.27-2.91)
p-value: p=0.002
High-power short-duration radiofrequency ablation for atrial fibrillation significantly reduces procedure time and improves 1-year freedom from atrial arrhythmia compared to conventional ablation, without increasing complications.
Supports HPSD (40-50W) ablation for AF; extends RCT evidence for higher 1-year success and shorter procedures.
Aims: We aimed to further evaluate the effectiveness and safety between high-power short-duration (HPSD) radiofrequency ablation (RFA) and conventional RFA in patients with atrial fibrillation (AF). Methods: Studies comparing HPSD and conventional applications from inception through December 2021 were searched on Pubmed, Medline, Cochrane and Clinicaltrials.gov. Results: The meta-analysis included seventeen studies with a total of 4934 patients. HPSD group decreased procedure duration [mean difference (MD) -38.28 min, 95% confidence interval (CI) -47.08 to -29.49, P＜0.001], RF duration (MD -20.51 min, 95% CI -25.96 to -15.06, P＜0.001) and fluoroscopy duration (MD -5.19 min, 95% CI -8.02 to -2.37, P＜0.001), while improving the rates of first-pass isolation [Odds Ratio (OR) 8.92, 95% CI 2.40-33.09, P=0.009]. Compared with conventional group, freedom from atrial arrhythmia at 1-year-followup was higher in the HPSD group with a power setting of 40-50W (OR 1.93, 95% CI 1.27-2.91, P=0.002), nevertheless, two groups had similar effectiveness with a power setting of 50W in the HPSD RFA (OR 1.10, 95% CI 0.83-1.46, P=0.52). Acute pulmonary vein reconnection (P＜0.001) was significantly lower in the HPSD group. There was no difference in complications between the two groups (P=0.71). Conclusion: HPSD RFA was associated with shorter procedure duration, higher freedom from atrial arrhythmia and comparable safety when compared with conventional RFA.
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Jin et al. (2022) conducted a meta-analysis in Atrial fibrillation (AF) (n=4,934). High-power short-duration (HPSD) radiofrequency ablation vs. Conventional radiofrequency ablation was evaluated on Freedom from atrial arrhythmia at 1-year follow-up (40-50W power setting) (OR 1.93, 95% CI 1.27-2.91, p=0.002). High-power short-duration radiofrequency ablation (40-50W) increased freedom from atrial arrhythmia at 1 year compared to conventional ablation (OR 1.93; 95% CI 1.27-2.91; P=0.002).
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