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

Abstract

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.

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

“…Only one other NMA comparing the utility of vHPSD versus HPSD versus LPLD strategies exist 63 . On frequentist NMA, Tokavanich et al.…”

“…Other existing meta-analyses investigating vHPSD, HPSD, and LPLD Only one other NMA comparing the utility of vHPSD versus HPSD versus LPLD strategies exist. 63 On frequentist NMA, Tokavanich et al…”

Safety and effectiveness of the first contact force ablation catheter with a flexible tip

“…These results re-emphasize that the TactiFlex SE is safe and effective for use in the treatment of paroxysmal AF in the full range of 20 to 50 W. Usage of the TactiFlex SE at power ranges ≥40 W may be more procedurally efficient and clinically effective than usage at lower powers. Previous meta-analyses have concluded that there is no difference in the safety risk profile between high power, short duration (HPSD) (≥40 W) and low power, long duration (<40 W), 17 , 18 and that HPSD may have a lower risk of esophageal thermal injury. 19 However, a recent randomized trial observed higher rates of asymptomatic cerebral emboli in the HPSD arm, 20 and if this observation is replicated additional study on the significance of these asymptomatic cerebral emboli may be warranted.…”

High-Power Short-Duration Ablation of Paroxysmal and Persistent Atrial Fibrillation

“…3 ) [ 34 ]. Moreover, a systematic review and metanalysis, including studies that compared vHPSD vs. HPSD ablation, showed similar efficacy and safety outcomes between the two approaches [ 35 ]. In preclinical studies, tissue temperatures achieved with HPSD ablation guided by ablation index (AI) have been reported as similar to those obtained with vHPSD ablation [ 36 ].…”