Meta-analysis of high power short duration in atrial fibrillation ablation – a superior efficient ablation strategy

Xu, Min; Yang, Yan; Zhang, Dayong; Jiang, Weifeng

doi:10.1080/00015385.2021.1939512

Cited by 15 publications

(16 citation statements)

References 33 publications

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“…In addition, the AT/AFL recurrence rate did not differ between the two groups, which is a significant departure from the findings of previous meta-analyses. [5] From a safety standpoint, our meta-analysis demonstrated that implementing radiofrequency ablation for atrial fibrillation (AF) using the HPSD strategy may decrease the likelihood of ETI. In percentage terms, however, this result was more significant than previous meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

“…In percentage terms, however, this result was more significant than previous meta-analyses. [5,35] The HP approach was also associated with a reduced risk of complications such as pericardial tamponade, atrial-esophageal fistula, stroke, and phrenic nerve injury. The HPSD approach increased first-pass pulmonary vein isolation (FPI) and decreased acute pulmonary vein re-isolation (PVR) rate.…”

Section: Discussionmentioning

confidence: 99%

“…(4) Furthermore, we compared our meta-analysis to those conducted by Min Xu et al in the past. The fifteen studies comprising [5] were predominantly retrospective studies and RCTs. Our meta-analysis entailed a plethora of prospective studies that may have addressed biases inherent to retrospective studies.…”

Section: Lesion Variations and Complicationsmentioning

confidence: 99%

“…[5] Radiofrequency (RF) energy is conveyed as low-power, long-duration (LPLD) lesions steered by factors such as the force-time integral (FTI); however, the ideal ablation specifications to accomplish resilient, long-term pulmonary vein isolation (PVI) in a relatively secure manner remain to be ascertained. [4,5] HPSD lesions are gaining in popularity due to the resistive combustion of extracardiac frameworks; this technique may minimize procedure and fluoroscopy durations, as well as the risk of adverse effects. [6] Conductive heating dominates the low-power, long-duration RF ablation.…”

Section: Introductionmentioning

confidence: 99%

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Comparative efficacy and safety profile of high-power short duration with low power long duration radiofrequency ablation in atrial fibrillation: An updated systematic review and meta-analysis

Kumar

Khatri

Kumar

et al. 2023

Preprint

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Background: High power short duration (HPSD) radiofrequency ablation was expected to be more effective and safer than low power long duration (LPLD) in treating atrial fibrillation (AF). Given the limited data, the findings were controversial. This meta-analysis evaluated whether HPSD’s clinical effects outweigh LPLD’s. Methods: A systematic search of PubMed, EMBASE, and Google Scholar databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model. Results: This analysis included 21 studies with a total of 4169 patients. Pooled analyses revealed that HPSD was associated with a lower recurrence of atrial tachyarrhythmias (ATAs) at one year (RR: 0.62; 95% CI: 0.50 to 0.78, p: 0.00001, I : 0%). Furthermore, the HPSD approach reduced the risk of AF recurrence (RR: 0.64; 95% CI: 0.40 to 1.01, p: 0.06, I : 86%), The HPSD approach was associated with a lower risk of esophageal thermal injury (ETI) (RR: 0.78; 95% CI: 0.58 to 1.04, p: 0.09, I : 73%;). The HPSD strategy increased first-pass pulmonary vein isolation (FPI) and decreased acute pulmonary vein re-connection (PVR) both of which were predominantly manifested in bilateral and left pulmonary veins (PVs). HPSD demonstrated a reduction in procedural time, ablation number for pulmonary vein isolation (PVI), and fluoroscopy time. Conclusion: The HPSD method reduces ETI, PV reconnection, and recurrent AF. The HPSD approach also reduced procedural time, PVI ablation number, fluoroscopy time, and post-ablation AF relapse in one year, improving patient outcomes and safety.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Lesion Variations and Complicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparative efficacy and safety profile of high-power short duration with low power long duration radiofrequency ablation in atrial fibrillation: An updated systematic review and meta-analysis

Kumar

Khatri

Kumar

et al. 2023

Preprint

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“…1 HPSD ablation potentially reduces the recurrence rate of AF 1 year after the ablation compared with conventional low-power ablation (<40 W). 2,3 This method also reduces the overall procedural time compared with conventional power ablation. The use of high power is relatively safe when compared with the conventional method, as evidence suggests that serious complications are not different between the two methods.…”

Section: Introductionmentioning

confidence: 99%

Network meta‐analysis and systematic review comparing efficacy and safety between very high power short duration, high power short duration, and conventional radiofrequency ablation of atrial fibrillation

Tokavanich

Prasitlumkum

Kewcharoen

et al. 2023

Cardiovasc electrophysiol

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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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High-Power Short-Duration Radiofrequency Ablation of Atrial Fibrillation

Wojtaszczyk

Kaczmarek

Ptaszyński

2022

Innovative Treatment Strategies for Clinical Electrophysiology

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Meta-analysis of high power short duration in atrial fibrillation ablation – a superior efficient ablation strategy

Cited by 15 publications

References 33 publications

Comparative efficacy and safety profile of high-power short duration with low power long duration radiofrequency ablation in atrial fibrillation: An updated systematic review and meta-analysis

Comparative efficacy and safety profile of high-power short duration with low power long duration radiofrequency ablation in atrial fibrillation: An updated systematic review and meta-analysis

Network meta‐analysis and systematic review comparing efficacy and safety between very high power short duration, high power short duration, and conventional radiofrequency ablation of atrial fibrillation

High-Power Short-Duration Radiofrequency Ablation of Atrial Fibrillation

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