High-power short duration vs. conventional radiofrequency ablation of atrial fibrillation: a systematic review and meta-analysis

Aims We sought to compare the effectiveness and safety of high-power short-duration (HPSD) radiofrequency ablation (RFA) with conventional RFA in patients with atrial fibrillation (AF). Methods and results MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 15 May 2020 for relevant studies comparing HPSD vs. conventional RFA in patients undergoing initial catheter ablation for AF. A total of 15 studies involving 3718 adult patients were included in our meta-analysis (2357 in HPSD RFA and 1361 in conventional RFA). Freedom from atrial arrhythmia was higher in HPSD RFA when compared with conventional RFA [odds ratio (OR) 1.44, 95% confidence interval (CI) 1.10-1.90; P = 0.009]. Acute PV reconnection was lower (OR 0.56, P = 0.005) and first-pass isolation was higher (OR 3.58, P < 0.001) with HPSD RFA. There was no difference in total complications between the two groups (P = 0.19). Total procedure duration [mean difference (MD) -37.35 min, P < 0.001], fluoroscopy duration (MD -5.23 min, P = 0.001), and RF ablation time (MD -16.26 min, P < 0.001) were all significantly lower in HPSD RFA. High-power short-duration RFA also demonstrated higher freedom from atrial arrhythmia in the subgroup analysis of patients with paroxysmal AF (OR 1.80, 95% CI 1.29-2.50; P < 0.001), studies with >= 50 W protocol in the HPSD RFA group (OR 1.53, 95% CI 1.08-2.18; P = 0.02] and studies with contact force sensing catheter use (OR 1.65, 95% CI 1.21-2.25; P = 0.002). Conclusion High-power short-duration RFA was associated with better procedural effectiveness when compared with conventional RFA with comparable safety and shorter procedural duration.