Procedural characteristics of pulmonary vein isolation with high-power short-duration setting compared to conventional setting

Hijioka, Naoko; Kaneshiro, Takashi; Nehashi, Takeshi; Amami, Kazuaki; Nodera, Minoru; Yamada, Shuichi; Kamioka, Masashi; Ishida, Takafumi; Takeishi, Yasuchika

doi:10.1186/s12872-022-02459-2

Cited by 3 publications

(5 citation statements)

References 24 publications

(29 reference statements)

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“…Thus, the final analysis included 29 studies 8,24–51 (3 randomized studies and 26 observational studies), analyzing 9721 patients. vHPSD ablation was performed in five studies (four studies with 90‐W ablation and one study with 70‐W ablation).…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…Of 212 potential articles screened, 36 studies comprising 10,375 patients were included (Figure 1). Table 1 summarizes the characteristics of included studies 15,17,28–61 . Two studies were RCTs while the rest were observational.…”

Section: Resultsmentioning

confidence: 99%

“…15,17, Two studies were RCTs while the rest were observational. 41 (37)(38)(39)(40)(41)(42)(43)(44)(45)(46) Abbreviations: AF, atrial fibrillation; HPSD, high-power short-duration; LAD, left atrial diameter; LPLD, low-power long-duration; LVEF, left ventricular ejection fraction; IQR, inter-quartile range; mm, millimeter; SD, standard deviation; no., number; NR, not reported; vHPSD, very high-power short-duration.…”

Section: Study Selectionmentioning

confidence: 99%

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

Junarta,

Rodriguez,

Ullah

et al. 2023

Pacing Clinical Electrophis

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BackgroundThe optimal power and duration settings for radiofrequency (RF) atrial fibrillation (AF) ablation to improve efficacy and safety is unclear. We compared low‐power long‐duration (LPLD), high‐power short‐duration (HPSD), and very HPSD (vHPSD) RF settings for AF ablation.MethodsThis network meta‐analysis (NMA) was structured according to the Preferred Reporting Items for Systematic Review and Meta‐Analyses guidelines. Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Observational and randomized studies were included. Eligible studies compared outcomes in AF patients who underwent first‐time RF ablation with the following settings: vHPSD (70–90 W, 3–10 s), HPSD (45–60 W, 5–10 s), or LPLD (20–40 W, 20–60 s).ResultsThirty‐six studies comprising 10,375 patients were included (33% female). Frequentist NMA showed LPLD tended toward a lower odds of freedom from arrhythmia (FFA) versus HPSD (OR 0.93, 95% CI 0.86–1.00). There was no difference in FFA between vHPSD versus HPSD. Splitwise interval estimates showed a lower odds of FFA in LPLD versus vHPSD on direct (OR 0.78, 95% CI 0.65–0.93) and network estimates (OR 0.85, 95% CI 0.73–0.98). Frequentist NMA showed less total procedural (TP) time with HPSD versus LPLD (generic variance 1.06, 95% CI 0.83 to 1.29) and no difference between HPSD versus vHPSD.ConclusionThis NMA shows improved procedural times in HPSD and vHPSD versus LPLD. Although HPSD tended toward improved odds of FFA compared to LPLD, the overall result was not statistically significant. The odds of FFA in LPLD was lower versus vHPSD on direct and network estimates on splitwise interval analysis. Large prospective head‐to‐head randomized trials are needed to validate HPSD and vHPSD settings.

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“…The objective of ablation is to produce transmural lesions while minimizing collateral damage to important structures. A high-power ablation strategy for PVI has been demonstrated to create contiguous and durable RF lesions without compromise on complications in several studies (1)(2)(3)(4)(5)(6). The delivered energy causes lesions through a combination of resistive and conductive heating phases.…”

Section: Ablation Index-guided High-power Ablationmentioning

confidence: 99%

“…In recent years, there has been a growing interest in the highpower ablation strategy (1)(2)(3)(4)(5)(6). The ablation index (AI), which weighs contact force (CF), radiofrequency time, and applied power, has been shown to aid in the creation of long-lasting ablation lesions (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Ablation index-guided high-power ablation for superior vena cava isolation in patients with atrial fibrillation

Cui

Dong

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe strategy of ablation index (AI)-guided high-power ablation seems to be a novel strategy for performing pulmonary vein isolation (PVI). An AI-guided high-power ablation strategy was used in this study to determine whether superior vena cava isolation (SVCI) after PVI was feasible and safe for patients with AF.MethodsData from 53 patients with AF were collected. Mapping and ablation of SVC were performed. The applied power was set at 45 W and the procedure was guided by AI. The SVC was divided into six segments in a cranial view. The RF applications and AI values in different segments were compared and analyzed. Using receiver operating characteristic (ROC) analysis, the diagnostic accuracy of AI value for predicting segment block was evaluated.ResultsElectrical SVCIs were successfully achieved in all patients. SVCI was performed by segment ablation in most cases, with RF applications in different segments. The mean AI value in non-lateral walls was higher than that of the lateral wall (392 ± 28 vs. 371 ± 37, P < 0.001). Acutely blocked sites had significantly larger AI values compared with no-blocked sites (390 ± 30 vs. 343 ± 23, P < 0.001). The optimal AI cut-off value for non-lateral segments was 379 (sensitivity: 75.9%, specificity: 100%) and for lateral segments was 345 (sensitivity: 82.3%, specificity: 100%).ConclusionThe AI values were predictive of the acute conduction block of SVCI. With AI values of 345 and 379, respectively, conduction block was achieved in the lateral walls at a lower level than in the non-lateral walls.

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Procedural characteristics of pulmonary vein isolation with high-power short-duration setting compared to conventional setting

Cited by 3 publications

References 24 publications

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

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

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

Ablation index-guided high-power ablation for superior vena cava isolation in patients with atrial fibrillation

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