Dataset Information

The superiority of high-power short-duration radiofrequency catheter ablation strategy for atrial fibrillation treatment: A systematic review and meta-analysis study.

ABSTRACT:

Background

Radiofrequency catheter ablation (RFCA) using the high-power short duration (HPSD) results in better ablation lesion formation in the swine model. This systematic review and meta-analysis purposed to investigate the safety and efficacy profile between HPSD and low-power long-duration (LPLD) ablation strategies to treat atrial fibrillation (AF) patients.

Methods

We completed the literature review after identifying the relevant articles comparing HPSD and LPLD ablation methods for AF recorded in ClinicalTrials.com, CENTRAL, PubMed, and ScienceDirect until February 2021. The overall effects were calculated using pooled risk ratio (RR) and mean difference (MD) for categorical and continuous data, respectively. We also estimated the 95% confidence interval (CI).

Results

The HPSD strategy took shorter procedure time (MD = -33.75 min; 95% CI = -44.54 to -22.97; P < .01), fluoroscopy time (MD = -5.73 min; 95% CI = -8.77 to -2.70; P < .001), and ablation time (MD = -17.71; 95% CI = -21.02 to -14.41) than LPLD strategy. The HPSD RFCA was correlated with lower risk of esophageal thermal injury (RR = 0.75; 95% CI = 0.59 to 0.94; P = .02). The HPSD method resulted in higher first-pass pulmonary vein isolation (PVI) (RR = 1.36; 95% CI = 1.13 to 1.64; P < .01), lower PV reconnection (RR = 0.47; 95% CI = 0.34 to 0.64; P < .01), and lower recurrent AF (RR = 0.72; 95% CI = 0.54 to 0.96; P = .02) than LPLD strategy.

Conclusion

HPSD RFCA was superior to the conventional LPLD RFCA in terms of safety and efficacy in treating AF patients.

SUBMITTER: Waranugraha Y

PROVIDER: S-EPMC8339091 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:High-power short-duration (HPSD) setting during radiofrequency ablation has become an attempt to improve atrial fibrillation (AF) treatment outcomes. This study ought to compare the efficacy, safety, and effectiveness between HPSD and conventional settings. PubMed, Embase, and Cochrane Library were searched. Studies that compared HPSD and conventional radiofrequency ablation settings in AF patients were included while studies performed additional ablations on nonpulmonary vein targets without clear recording were excluded. Data were pooled with random-effect model. Efficacy endpoints include first-pass pulmonary vein isolation (PVI), acute pulmonary vein (PV) reconnection, free from AF, and free from atrial tachycardia (AT) during follow-up. Safety endpoints include esophagus injury rate and major complication rate. Effectiveness endpoints include complete PVI rate, total procedure time, PVI time, and PVI radiofrequency ablation (PVI RF) time. We included 22 studies with 3867 atrial fibrillation patients in total (2393 patients received HPSD radiofrequency ablation). Perioperatively, the HPSD group showed a higher first-pass PVI rate (risk ratio, RR = 1.10, P = 0.0001) and less acute PV reconnection rate (RR = 0.56, P = 0.0004) than the conventional group. During follow-up, free from AF (RR = 1.11, P = 0.16) or AT (RR = 1.06, P = 0.24) rate did not differ between HPSD and conventional groups 6-month postsurgery. However, the HPSD group showed both higher free from AF (RR = 1.17, P = 0.0003) and AT (RR = 1.11, P < 0.0001) rate than the conventional group 12-month postsurgery. The esophagus injury (RR = 0.99, P = 0.98) and major complications (RR = 0.76, P = 0.70) rates did not differ between the two groups. The HPSD group took shorter total procedure time (MD = -33.71 95% CI: -43.10 to -24.33, P < 0.00001), PVI time (MD = -21.60 95% CI: -25.00 to -18.21, P < 0.00001), and PVI RF time (MD = -13.72, 95% CI: -14.45 to -13.00, P < 0.00001) than conventional groups while complete procedure rate did not differ between two groups (RR = 1.00, P = 0.93). HPSD setting during AF radiofrequency ablation has better effectiveness, efficacy, and similar safety compared with the conventional setting.