Safety and efficacy of high power shorter duration ablation for atrial fibrillation: A systematic review and meta-analysis

Background Radiofrequency ablation in patients with atrial fibrillation (AF) is effective but hampered by pulmonary veins reconnection because of insufficient lesions. High power shorter duration ablation (HPSD) was 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 < .001]. HPSD could reduce recurrence of atrial arrhythmias (RR: 0.70; 95% CI: 0.50-0.98, P = .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 < .001], ablation time (WMD: -21.25; 95% CI: -25.36 to -17.13, P < .001), and fluoroscopy time (WMD: -4.13; 95% CI: -7.52 to -0.74, P < .001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44-1.30, P = .31) and (RR: 0.64; 95% CI: 0.17-2.39, P = .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 LPLD. Moreover, major complications and ETI were similar between two groups.