October 27, 2020Clinical CardiologyOpen Access

Comparison of high‐power short‐duration and low‐power long‐duration radiofrequency ablation for treating atrial fibrillation: Systematic review and meta‐analysis

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Why the study?

Comparative data between high-power short-duration and low-power longer-duration ablation for treating atrial fibrillation are limited.

Does high-power short-duration radiofrequency ablation improve first-pass PVI and reduce recurrence of atrial arrhythmias in patients with atrial fibrillation compared to low-power long-duration ablation?

Structured PICO

Population

10 trials pooling 2,467 patients with drug-refractory symptomatic atrial fibrillation (AF) undergoing radiofrequency catheter ablation for the first time. Mean ages ranged from 58.7 to 69 years.

Intervention

High-power short-duration (HPSD) radiofrequency ablation (power > 40 W, duration 2-10 seconds per site)

Comparator

Low-power long-duration (LPLD) radiofrequency ablation (power 20-40 W, duration 10-30 seconds per site)

Outcome

First-pass pulmonary vein isolation (PVI) and recurrence of atrial arrhythmias

High-power short-duration radiofrequency ablation is safe and more effective than low-power long-duration ablation for treating atrial fibrillation, offering higher first-pass PVI rates, lower arrhythmia recurrence, and shorter procedural times.

Limitations

Publication bias could not be completely excluded
Number of included studies was limited to 10, and most were nonrandomized
Collateral tissue damage was not completely reflected due to limited endpoints and heterogeneity of ETIs
Ablation power and duration settings in the included studies were not completely consistent

Implication

HPSD ablation may improve AF freedom and procedural efficiency; extends randomized trial evidence via meta-analysis.

Abstract

BACKGROUND: High power shorter duration (HPSD) ablation seen to increase efficacy and safety treating of atrial fibrillation (AF); however, comparative data between HPSD and low power longer duration (LPLD) ablation are limited. HYPOTHESIS: We thought that HPSD might bring more clinical benefits. The aim of this meta-analysis was to evaluate the clinical benefits of HPSD in patients with AF. METHODS: The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and LPLD ablation. RESULTS: Ten trials with 2467 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first-pass pulmonary vein isolation (PVI) (risk ratio [RR]: 1.20; 95% confidence interval [CI]: 1.10-1.31, P < .001) and recurrence of atrial arrhythmias (RR: 0.73; 95% CI: 0.58-0.91, P = .005). Additionally, HPSD could reduce procedural time (weighted mean difference [WMD]: -42.93; 95% CI, -58.10 to -27.75, P < .001), ablation time (WMD: -21.01; 95% CI: -24.55 to -17.47, P < .001), and fluoroscopy time (WMD: -4.11; 95% CI: -6.78 to -1.45, P < .001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44-1.30, P = .31) and (RR: 0.57; 95% CI: 0.21-1.51, P = .26). CONCLUSIONS: HPSD was safe and efficient for treating AF. Compared with LPLD, HPSD was associated with advantages of procedural features, higher first-pass PVI and reducing recurrence of atrial arrhythmias. Moreover, major complications and ETI were similar between two groups.