Key result
HPSD ablation cuts recurrent AF ~28% vs. conventional ablation with less esophageal injury.
Why the study?
Although high-power short-duration RFCA showed better lesion formation in swine models, its safety and efficacy compared with low-power long-duration ablation in AF patients required systematic investigation.
Does high-power short-duration radiofrequency catheter ablation improve procedural efficiency, safety, and efficacy compared to low-power long-duration ablation in patients with atrial fibrillation?
Meta-Analysis (n=2,901)
Does high-power short-duration radiofrequency catheter ablation improve procedural efficiency, safety, and efficacy compared to low-power long-duration ablation in patients with atrial fibrillation?
Relative Risk: 0.72 (95% CI 0.54–0.96)
p-value: p=0.02
Supports high-power short-duration ablation as preferred for atrial fibrillation; confirms lower recurrence and esophageal injury versus low-power long-duration.
Background Radiofrequency catheter ablation (RFCA) using the high‐power short duration (HPSD) results in better ablation lesion formation in the swine model. This systematic review and meta‐analysis purposed to investigate the safety and efficacy profile between HPSD and low‐power long‐duration (LPLD) ablation strategies to treat atrial fibrillation (AF) patients. Methods We completed the literature review after identifying the relevant articles comparing HPSD and LPLD ablation methods for AF recorded in ClinicalTrials.com, CENTRAL, PubMed, and ScienceDirect until February 2021. The overall effects were calculated using pooled risk ratio (RR) and mean difference (MD) for categorical and continuous data, respectively. We also estimated the 95% confidence interval (CI). Results The HPSD strategy took shorter procedure time (MD = −33.75 min; 95% CI = −44.54 to −22.97; P < .01), fluoroscopy time (MD = −5.73 min; 95% CI = −8.77 to −2.70; P < .001), and ablation time (MD = −17.71; 95% CI = −21.02 to −14.41) than LPLD strategy. The HPSD RFCA was correlated with lower risk of esophageal thermal injury (RR = 0.75; 95% CI = 0.59 to 0.94; P = .02). The HPSD method resulted in higher first‐pass pulmonary vein isolation (PVI) (RR = 1.36; 95% CI = 1.13 to 1.64; P < .01), lower PV reconnection (RR = 0.47; 95% CI = 0.34 to 0.64; P < .01), and lower recurrent AF (RR = 0.72; 95% CI = 0.54 to 0.96; P = .02) than LPLD strategy. Conclusion HPSD RFCA was superior to the conventional LPLD RFCA in terms of safety and efficacy in treating AF patients.
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Waranugraha et al. (2021) conducted a meta-analysis in Atrial fibrillation (n=2,901). High-power short-duration (HPSD) radiofrequency catheter ablation vs. Low-power long-duration (LPLD) radiofrequency catheter ablation was evaluated on Recurrent atrial fibrillation (RR 0.72, 95% CI 0.54 to 0.96, p=0.02). High-power short-duration radiofrequency catheter ablation significantly reduced the risk of recurrent atrial fibrillation (RR 0.72) and esophageal thermal injury compared to the conventional low-power long-duration strategy.
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