1 INTRODUCTION
Pulmonary vein isolation (PVI) is established as the cornerstone for treating AF 1. Efficacy of PVI is associated with trans-mural, continuous, permanent cellular damage2. Multiple factors outside of power can impact energy delivery to the tissue and total energy delivered may be amplified or attenuated depending on contact force (CF) and catheter stability3, 4. Despite the technical advances with force sensing and stability monitoring, the rate of PVs reconnection remains frequently with Low power longer duration (LPLD) (20~40W, with longer ablation duration of 10–30 s per site). Because retaining catheter stability in a constantly working heart for a long time is very difficult, and tissue edema by long duration ablation limits effective ablation2. Moreover, the left atrium is adjacent to the esophagus, injury depth may be excessive by long duration ablation despite a lower power setting, thus increasing the risk of esophageal thermal injury (ETI) 5. Simultaneously, a large fluid volume infused via a catheter during ablation, which is proportional to the ablation time, can induce acute heart failure in patients with impaired left ventricular function6. In order to optimize AF ablation, a novel energy delivery strategy with high power shorter duration (HPSD) ablation was applied for AF treatment7. To create similar lesions, the ablation time is longer by LPLD than HPSD ablation.
HPSD ablation has been supposed to increase efficacy and minimize deep tissue injury. However, studies comparing data between the HPSD and LPLD approaches were limited and inconsistent. Therefore, this systematic review and meta-analysis was performed to evaluate the efficacy and safety of HPSD compared with LPLD in treating AF.