Meta-Analysis Comparing Outcomes of High-Power Short-Duration and Low-Power Long-Duration Radiofrequency Ablation for Atrial Fibrillation

Authors

Dibbendhu Khanra
Abdul Hamid
Saurabh Deshpande
Anindya Mukherjee
Sanjiv Petkar
Mohammad Saeed
Indranill Basu-Ray

Publication Date

1-1-2022

Journal

Anatolian Journal of Cardiology

DOI

10.5152/AnatolJCardiol.2021.243

PMID

35191380

PMCID

PMC8878944

PubMedCentral® Posted Date

1-26-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Atrial Fibrillation, Catheter Ablation, Humans, Pulmonary Veins, Radiofrequency Ablation, Recurrence, Treatment Outcome, atrial fibrillation, catheter ablation, esophageal injury, pulmonary vein reconnections, recurrence

Abstract

OBJECTIVE: High power short duration (HPSD) ablation strategy is proposed to be more effective than low power long duration (LPLD) for radiofrequency ablation of atrial fibrillation. Although small trials abound, data from a large cohort are lacking. This meta-analysis compares all the existing studies comparing these two approaches to evaluate perceived advantages of one over the other.

METHODS: A systematic search of PubMed, EMBASE, and Cochrane databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model.

RESULTS: Ablation settings varied widely across 20 studies comprising 2,136 patients who underwent HPSD and 1,753 patients who underwent LPLD. The pooled incidence of atrial arrhythmia recurrence after HPSD ablation was 20% [95% confidence interval (CI): 0.16-0.25; I2=88%]. Atrial arrhythmia recurrences were significantly less frequent with HPSD ablation (incidence risk ratio=0.66; 95% CI: 0.49-0.88; I2=72%; p=0.004). Procedural, fluoroscopy, and ablation times were significantly shorter with HPSD ablation. First-pass pulmonary vein isolations (PVIs) were significantly more [odds ratio (OR)=2.94; 95% CI: 1.50-5.77; I2=89%; p=0.002), and acute pulmonary vein reconnections (PVRs) were significantly lesser (OR=0.41; 95% CI: 0.28-0.62; I2=62%; p

CONCLUSION: HPSD ablation enables faster first-pass PVI with fewer PVRs, similar ETI rates, rare collateral damage, and lower recurrence of atrial arrhythmia in the long term than LPLD. Randomized controlled studies with a larger cohort are indicated both to confirm the benefit of HPSD ablation and standardize the ablation protocol.

Comments

Associated Data