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.