Comparison of Effectiveness and Safety between High-Power Short-Duration Ablation and Conventional Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract

Aim. We aimed to evaluate the effectiveness and safety between high-power short-duration (HPSD) radiofrequency ablation (RFA) and conventional RFA in patients with atrial fibrillation (AF). Methods. Studies comparing HPSD and traditional applications in patients undergoing initial catheter ablation for atrial fibrillation from inception through December 2021 were searched on Pubmed, Medline, Cochrane, and Clinicaltrials.gov. Results. The meta-analysis included seventeen studies with a total of 4934 patients. HPSD group decreased procedure duration (mean difference (MD) −38.28 min, P < 0.001 ), RF duration (MD −20.51 min, P < 0.001 ), fluoroscopy duration (MD −5.19 min, P < 0.001 ), and acute pulmonary vein reconnection (Odds ratio (OR) 0.40, P < 0.001 ), while improving the freedom from atrial arrhythmia at one year (OR 1.48, 95% confidence interval (CI) 1.12–1.94, P = 0.005 ) and rates of first-pass isolation (OR 8.92, P = 0.001 ). Compared with the conventional group, freedom from atrial arrhythmia at one-year follow-up was higher in the HPSD group without the guidance of AI/LSI (OR 1.66, P = 0.01 ) and studies with a power setting of 40–50 W (OR 1.93, P = 0.002 ). Nevertheless, the two groups had similar effectiveness with a power setting of 50 W in the HPSD RFA (OR 1.10, P = 0.52 ). There was no difference in complications between the two groups ( P = 0.71 ). Conclusion. HPSD RFA was associated with shorter procedure duration, higher freedom from atrial arrhythmia, and comparable safety compared to conventional RFA.

Single ring isolation is superior to circumferential pulmonary vein isolation plus modified posterior box isolation with a high power of 40-45 W in patients with persistent atrial fibrillation

“…The high-power short-duration (HPSD) ablation strategy comprises the use of higher RFCA power (≥ 40 W) and a shorter duration (5-15 s) of each RF energy application, and HPSD ablation results in larger lesion diameters and smaller lesion depths compared to conventional (20-35 W, 10-30 s) applications 28 . Highpower ablation was previously associated with better procedural effectiveness than conventional RFCA with low power 29 . Based on these studies, in our study, the ndings demonstrated the effectiveness of SRI with a high power of 40-45 w in restoring sinus rhythm, and it was also superior to CPVI + MPOBI.…”

Comparison of very high‐power short‐duration, high‐power short‐duration, and low‐power long‐duration radiofrequency ablation for atrial fibrillation: A systematic review and network meta‐analysis

“…These MA have included anywhere between 7 to 22 studies with 1013 to 4934 patients in their pooled analysis. Seven of these MA have demonstrated improved FFA with HPSD in their primary analysis when both persistent and paroxysmal AF patients are included 6,7,9–11,13,14 . Only one of these MA conducted a sub‐group analysis comparing outcomes stratified by AF type, be it paroxysmal or persistent AF.…”

“…Currently, there are 9 MA comparing the utility of HPSD versus LPLD for AF ablation in the literature. [6][7][8][9][10][11][12][13][14] These MA have included anywhere between 7 to 22 studies with 1013 to 4934 patients in their pooled analysis. Seven of these MA have demonstrated improved FFA with HPSD in their primary analysis when both persistent and paroxysmal AF patients are included.…”

“…The use of high‐power (45–60 W) short duration (5–10 s) (HPSD) settings to reduce AF recurrence results in shorter ablation times and improves procedural safety. Multiple recent meta‐analyses (MA) comparing HPSD versus LPLD for initial AF ablation have yielded conflicting results 6–14 . There have been only three randomized controlled trials (RCT) comparing HPSD and LPLD settings.…”

“…Multiple recent meta-analyses (MA) comparing HPSD versus LPLD for initial AF ablation have yielded conflicting results. [6][7][8][9][10][11][12][13][14] There have been only three randomized controlled trials (RCT) comparing HPSD and LPLD settings. These RCTs have yielded inconsistent results with regards to sinus rhythm maintenance.…”