HPSD ablation did not significantly increase freedom from atrial tachyarrhythmia at 12 months compared to LPLD ablation (OR 1.54; 95% CI 0.99-2.40; p=0.054).
Meta-Analysis (n=2,274)
Does a higher-power, shorter duration (HPSD) ablation strategy improve freedom from atrial tachyarrhythmia compared to a lower-power, longer duration (LPLD) strategy in patients undergoing atrial fibrillation ablation?
HPSD ablation for AF significantly reduces procedure and ablation times without increasing periprocedural complications, though overall freedom from atrial tachyarrhythmia was not significantly improved compared to LPLD.
Effect estimate: OR 1.54 (95% CI 0.99 to 2.40)
p-value: p=.054
BACKGROUND: Multiple strategies have advocation for power titration and catheter movement during atrial fibrillation (AF) ablation. Comparative favoring evidence regarding the efficacy, logistics, and safety of a higher-power, shorter duration (HPSD) ablation strategy compared to a lower-power, longer duration (LPLD) ablation strategy is insubstantial. We performed a meta-analysis to compare arrhythmia-free survival, procedure times, and complication rates between the two strategies. METHODS: We searched MEDLINE, EMBASE, and Cochrane Library from inception to September 2020. We included studies comparing patients who underwent HPSD and LPLD strategies for AF ablation and reporting either of the following outcomes: Freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. We combined data using the random-effects model to calculate the odds ratio (OR) and weight mean difference (WMD) with a 95% confidence interval (CI). RESULTS: Ten studies from 2006 to 2020 involving 2274 patients were included (1393 patients underwent HPSD strategy and 881 patients underwent LPLD strategy). HPSD strategy was not associated with increased freedom from AT at 12-month follow-up (OR = 1.54, 95% CI: 0.99 to 2.40, p = .054). In the subgroup analysis of the randomized controlled trial, the HPSD strategy was associated with increased freedom from AT compared to the LPLD strategy (OR = 3.12, 95% CI: 1.18 to 8.20, p = .02). There was a significant reduction in the HPSD group for the total procedure (WMD = 49.60, 95% CI: 29.76 to 69.44) and ablation (WMD = 17.92, 95% CI: 13.63 to 22.22) times, but not for fluoroscopy time (WMD = 1.15, 95% CI: -0.67 to 2.97). HPSD was not associated with a reduction in esophageal ulcer/atrioesophageal fistula (OR = 0.35, 95% CI: 0.12 to 1.06) or pericardial effusion/cardiac tamponade rates (OR = 1.16, 95% CI: 0.35 to 3.81). CONCLUSIONS: When compared to the LPLD strategy, the HPSD strategy does not improve recurrent AT nor reduce periprocedural complication risks. However, subgroup analysis of the randomized controlled trial showed that HPSD significantly reduces AT recurrence. An HPSD strategy can significantly reduce total procedure and ablation times.
Kewcharoen et al. (Fri,) conducted a meta-analysis in Atrial fibrillation (n=2,274). Higher-power, shorter duration (HPSD) ablation vs. Lower-power, longer duration (LPLD) ablation was evaluated on Freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter (OR 1.54, 95% CI 0.99 to 2.40, p=.054). HPSD ablation did not significantly increase freedom from atrial tachyarrhythmia at 12 months compared to LPLD ablation (OR 1.54; 95% CI 0.99-2.40; p=0.054).