Efficacy and safety of high-power short-duration ablation for atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials

Ahmed Mazen Amin; Ramy Ghaly; Ahmed A Ibrahim; Mohamed Ahmed Ali; Omar Almaadawy; Amr Elzahaby; Mohamed Abuelazm; Basel Abdelazeem; Muhammad Bilal Munir

doi:10.1007/s10840-024-01782-2

Efficacy and safety of high-power short-duration ablation for atrial fibrillation: a systematic review and meta-analysis of randomized controlled trials

J Interv Card Electrophysiol. 2024 Mar 9. doi: 10.1007/s10840-024-01782-2. Online ahead of print.

Authors

Ahmed Mazen Amin¹, Ramy Ghaly², Ahmed A Ibrahim³, Mohamed Ahmed Ali⁴, Omar Almaadawy⁵, Amr Elzahaby⁶, Mohamed Abuelazm⁶, Basel Abdelazeem⁷, Muhammad Bilal Munir⁸

Affiliations

¹ Faculty of Medicine, Mansoura University, Mansoura, Egypt. ahmedmazenaliamin@gmail.com.
² Internal Medicine, University of Missouri-Kansas City, Kansas City, MO, USA.
³ Faculty of Medicine, Menoufia University, Menoufia, Egypt.
⁴ Qena Faculty of Medicine, South Valley University, Qena, Egypt.
⁵ Internal Medicine, MedStar Health, Baltimore, MD, USA.
⁶ Faculty of Medicine, Tanta University, Tanta, Egypt.
⁷ Department of Cardiology, West Virginia University, Morgantown, WV, USA.
⁸ Section of Electrophysiology, Division of Cardiology, Department of Medicine, University of California Davis, Sacramento, CA, USA.

PMID: 38460090
DOI: 10.1007/s10840-024-01782-2

Abstract

Background: High-power short-duration (HPSD) ablation has emerged as an alternative to conventional standard-power long-duration (SPLD) ablation. We aim to assess the efficacy and safety of HPSD versus SPLD for atrial fibrillation (AF) ablation.

Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, WOS, SCOPUS, EMBASE, and CENTRAL were performed through August 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI).

Prospero id: CRD42023471797.

Results: We included six RCTs with a total of 694 patients. HPSD was significantly associated with a decreased total procedure time (MD: -22.88 with 95% CI [-36.13, -9.63], P = 0.0007), pulmonary vein isolation (PVI) time (MD: -19.73 with 95% CI [-23.93, -15.53], P < 0.00001), radiofrequency time (MD: -10.53 with 95% CI [-12.87, -8.19], P < 0.00001). However, there was no significant difference between HPSD and SPLD ablation with respect to the fluoroscopy time (MD: -0.69 with 95% CI [-2.00, 0.62], P = 0.30), the incidence of esophageal lesions (RR: 1.15 with 95% CI [0.43, 3.07], P = 0.77), and the incidence of first pass isolation (RR: 0.98 with 95% CI [0.88, 1.08], P = 0.65).

Conclusion: HPSD ablation was significantly associated with decreased total procedure time, PVI time, and radiofrequency time compared with SPLD ablation. On the contrary, SPLD ablation was significantly associated with low maximum temperature.

Keywords: Ablation; Atrial fibrillation; HPSD; High Power; Pulmonary vein isolation.

Publication types

Review