Summary
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.
Key words: Atrial fibrillation; Low power longer duration
ablation; High power shorter duration ablation; Safety, Efficacy.