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High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Meta-Analysis
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  • Jakrin Kewcharoen,
  • Chol Techorueangwiwat,
  • Chanavuth Kanitsoraphan,
  • Thiratest Leesutipornchai,
  • Nazem Akoum,
  • Thomas Bunch,
  • T. Leenhapong Navaravong
Jakrin Kewcharoen
University of Hawaii Internal Medicine Residency Program
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Chol Techorueangwiwat
University of Hawai'i System
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Chanavuth Kanitsoraphan
University of Hawaii Internal Medicine Residency Program
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Thiratest Leesutipornchai
Chulalongkorn University
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Nazem Akoum
University of Washington
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Thomas Bunch
University of Utah School of Medicine
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T. Leenhapong Navaravong
University of Utah School of Medicine
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Abstract

Background: Multiple strategies have advocation for power titration and catheter movement during atrial fibrillation (AF) ablation. Comparative favoring evidence regarding the efficacy, logistics, and safety of a higher power, shorter duration (HPSD) ablation strategy compared to a lower power, longer duration (LPLD) ablation strategy is insubstantial. We performed a meta-analysis to compare arrhythmia-free survival, procedure times, and complication rates between the two strategies. Methods: We searched MEDLINE, EMBASE and Cochrane Library from inception to April 2020. We included studies comparing patients underwent HPSD and LPLD strategies for AF ablation and reporting either of the following outcomes: freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. We combined data using the random-effects model to calculate odds ratio (OR) and weight mean difference (WMD) with 95% confidence interval (CI). Results: Nine studies from 2006-2020 involving 2,282 patients were included (1,369 patients underwent HPSD strategy and 853 patients underwent LPLD strategy). HPSD strategy was not associated with an increased freedom from AT at 12-month follow-up (OR= 1.41, 95%CI:0.90-2.21). There was a significant reduction in the HPSD group for total procedure (WMD=49.60, 95%CI:29.76-69.44) and ablation (WMD=17.92, 95%CI:13.63-22.22) times, but not for fluoroscopy time (WMD=1.15, 95%CI:-0.67-2.97). HPSD was not associated with a reduction in esophageal ulcer/atrioesophageal fistula (OR=0.35, 95%CI:0.12-1.06) or pericardial effusion/cardiac tamponade rates (OR=0.96, 95%CI:0.24-3.79). Conclusions: When compared to a LPLD strategy, HPSD strategy does not improve recurrent AT nor reduce periprocedural complication risks. However, a HPSD strategy can significantly reduce total procedure and ablation times.

Peer review status:IN REVISION

24 Aug 2020Submitted to Journal of Cardiovascular Electrophysiology
24 Aug 2020Assigned to Editor
24 Aug 2020Submission Checks Completed
26 Aug 2020Reviewer(s) Assigned
19 Sep 2020Review(s) Completed, Editorial Evaluation Pending
21 Sep 2020Editorial Decision: Revise Minor