Why the study?
Very high-power short-duration ablation is a novel method using >50 W to obtain more durable AF ablation, but its efficacy and safety compared with HPSD and conventional ablation needed evaluation.
Does very high-power short-duration or high-power short-duration ablation improve efficacy and safety compared to conventional power ablation in patients with atrial fibrillation?
Does very high-power short-duration or high-power short-duration ablation improve efficacy and safety compared to conventional power ablation in patients with atrial fibrillation?
Very high-power short-duration ablation did not yield higher efficacy than high-power short-duration or conventional power ablation, though procedure times were shorter than conventional ablation and major complications were low across all techniques.
vHPSD shows no efficacy edge over HPSD; confirms HPSD as top-ranked for sinus rhythm maintenance while leaving durability questions open.
BACKGROUND: High-power short-duration (HPSD) atrial fibrillation (AF) ablation with a power of 40-50 W was proved to be safe and effective. Very high-power short-duration (vHPSD) AF ablation is a novel method using >50 W to obtain more durable AF ablation. This study aimed to evaluate the efficacy and safety of vHPSD ablation compared with HPSD ablation and conventional power ablation. METHODS: A literature search for studies that reported AF ablation outcomes, including short-term freedom from atrial arrhythmia, first-pass isolation (FPI) rate, procedure time, and major complications, was conducted utilizing MEDLINE, EMBASE, and Cochrane databases. All relevant studies were included in this analysis. A random-effects model of network meta-analysis and surface under cumulative ranking curve (SUCRA) were used to rank the treatment for all outcomes. RESULTS: A total of 29 studies with 9721 patients were included in the analysis. According to the SUCRA analysis, HPSD ablation had the highest probability of maintaining sinus rhythm. Point estimation showed an odds ratio of 1.5 (95% confidence interval [CI]: 1.2-1.9) between HPSD ablation and conventional power ablation and an odds ratio of 1.3 (95% CI: 0.78-2.2) between vHPSD ablation and conventional power ablation. While the odds ratio of FPI between HPSD ablation and conventional power ablation was 3.6 (95% CI: 1.5-8.9), the odds ratio between vHPSD ablation and conventional power ablation was 2.2 (95% CI: 0.61-8.6). The procedure times of vHPSD and HPSD ablations were comparable and, therefore, shorter than that of conventional power ablation. Major complications were low in all techniques. CONCLUSION: vHPSD ablation did not yield higher efficacy than HPSD ablation and conventional power ablation. With the safety concern, vHPSD ablation outcomes were comparable with those of other techniques.
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Tokavanich et al. (2023) studied this question.
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