High-power short-duration radiofrequency ablation was associated with higher freedom from atrial arrhythmia compared with conventional ablation (OR 1.44; 95% CI 1.10-1.90; P=0.009).
Meta-Analysis (n=3,718)
Does high-power short-duration radiofrequency ablation improve freedom from atrial arrhythmia in adult patients undergoing initial catheter ablation for atrial fibrillation?
High-power short-duration RFA is associated with higher freedom from atrial arrhythmia, shorter procedural times, and comparable safety compared to conventional RFA for initial AF ablation.
Odds Ratio: 1.44 (95% CI 1.1–1.9)
p-value: p=0.009
AIMS: We sought to compare the effectiveness and safety of high-power short-duration (HPSD) radiofrequency ablation (RFA) with conventional RFA in patients with atrial fibrillation (AF). METHODS AND RESULTS: MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 15 May 2020 for relevant studies comparing HPSD vs. conventional RFA in patients undergoing initial catheter ablation for AF. A total of 15 studies involving 3718 adult patients were included in our meta-analysis (2357 in HPSD RFA and 1361 in conventional RFA). Freedom from atrial arrhythmia was higher in HPSD RFA when compared with conventional RFA odds ratio (OR) 1.44, 95% confidence interval (CI) 1.10-1.90; P = 0.009. Acute PV reconnection was lower (OR 0.56, P = 0.005) and first-pass isolation was higher (OR 3.58, P < 0.001) with HPSD RFA. There was no difference in total complications between the two groups (P = 0.19). Total procedure duration mean difference (MD) -37.35 min, P < 0.001, fluoroscopy duration (MD -5.23 min, P = 0.001), and RF ablation time (MD -16.26 min, P < 0.001) were all significantly lower in HPSD RFA. High-power short-duration RFA also demonstrated higher freedom from atrial arrhythmia in the subgroup analysis of patients with paroxysmal AF (OR 1.80, 95% CI 1.29-2.50; P < 0.001), studies with ≥50 W protocol in the HPSD RFA group (OR 1.53, 95% CI 1.08-2.18; P = 0.02] and studies with contact force sensing catheter use (OR 1.65, 95% CI 1.21-2.25; P = 0.002). CONCLUSION: High-power short-duration RFA was associated with better procedural effectiveness when compared with conventional RFA with comparable safety and shorter procedural duration.
Ravi et al. (Tue,) conducted a meta-analysis in Atrial fibrillation (n=3,718). High-power short-duration (HPSD) radiofrequency ablation vs. Conventional radiofrequency ablation was evaluated on Freedom from atrial arrhythmia (OR 1.44, 95% CI 1.10-1.90, p=0.009). High-power short-duration radiofrequency ablation was associated with higher freedom from atrial arrhythmia compared with conventional ablation (OR 1.44; 95% CI 1.10-1.90; P=0.009).