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Safety and Efficacy of High Power Shorter duration Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis.
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  • miao-fu Li,
  • Jing Wu,
  • Chao-feng Chen,
  • Mei-jun Liu,
  • Yi-zhou Xu
miao-fu Li
Nanjing Medical University
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Jing Wu
Hangzhou First People's Hospital
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Chao-feng Chen
Hangzhou First People's Hospital
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Mei-jun Liu
Hangzhou First People's Hospital
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Yi-zhou Xu
Nanjing Medical University
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Abstract

Background: Radiofrequency ablation in patients with atrial fibrillation (AF) is effective but hampered by pulmonary veins reconnection due to insufficient lesions. High power shorter duration ablation (HPSD) seen to increase efficacy and safety. This analysis aimed to evaluate the clinical benefits of HPSD in patients with AF. Methods: The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and Low power longer duration (LPLD) ablation. Results: A total of seven trials with 2023 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first-pass pulmonary vein isolation (PVI) [risk ratio (RR): 1.27; 95% confidence interval (CI): 1.18–1.37, P < 0.001]. HPSD could reduce recurrence of atrial arrhythmias (RR: 0.70; 95% CI: 0.50–0.98, P = 0.04). Additionally, HPSD was more beneficial in terms of procedural time [Weighted Mean Difference, (WMD): −44.62; 95% CI, −63.00 to −26.23, P < 0.001], ablation time (WMD: −21.25; 95% CI: −25.36 to −17.13, P < 0.001), and fluoroscopy time (WMD: −4.13; 95% CI: −7.52 to −0.74, P < 0.001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44–1.30, P = 0.31) and (RR: 0.64; 95% CI: 0.17–2.39, P = 0.51). Conclusion: HPSD was safe and efficient for treating AF with clear advantages of procedural features, it also showed benefits of higher first-pass PVI and reducing recurrence of atrial arrhythmias compared with the LPLA. Moreover, major complications and ETI were similar between two groups.

Peer review status:ACCEPTED

14 Aug 2020Submitted to International Journal of Clinical Practice
15 Aug 2020Submission Checks Completed
15 Aug 2020Assigned to Editor
15 Aug 2020Reviewer(s) Assigned
06 Sep 2020Review(s) Completed, Editorial Evaluation Pending
08 Sep 20201st Revision Received
09 Sep 2020Submission Checks Completed
09 Sep 2020Assigned to Editor
09 Sep 2020Reviewer(s) Assigned
16 Sep 2020Review(s) Completed, Editorial Evaluation Pending
18 Sep 2020Editorial Decision: Accept