ISSN 2149-2263 | E-ISSN 2149-2271
Volume : 26 Issue : 1 Year : 2022
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The Anatolian Journal of Cardiology Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation [Anatol J Cardiol]
Anatol J Cardiol. 2022; 26(1): 2-14 | DOI: 10.5152/AnatolJCardiol.2021.243

Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation

Dibbendhu Khanra1, Abdul Hamid1, Saurabh Deshpande2, Anindya Mukherjee3, Sanjiv Petkar1, Mohammad Saeed4, Indranill Basu-ray5
1Heart and Lung Centre, New Cross Hospital, Royal Wolverhampton NHS Trust; Wolverhampton-United Kingdom
2Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research; Bangalore-India
3Department of Cardiology, Nilratan Sircar Medical College; Kolkata-India
4Department of Cardiology, Baylor College of Medicine; Texas-USA
5Memphis VA Medical Center; Tennessee-USA;School of Public Health, The University of Memphis; Tennessee-USA;Department of Cardiology, All India Institute of Medical Sciences (AIIMS); Rishikesh-India

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<0.001) in the HPSD group. Although radiofrequency energy was significantly higher, esophageal thermal injuries (ETI) were lower with HPSD ablation. Acute complications, including steam-pops, were rare and statistically similar in both the groups.
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.

Keywords: atrial fibrillation, catheter ablation, esophageal injury, pulmonary vein reconnections, recurrence

Dibbendhu Khanra, Abdul Hamid, Saurabh Deshpande, Anindya Mukherjee, Sanjiv Petkar, Mohammad Saeed, Indranill Basu-ray. Meta-analysis comparing outcomes of high-power short-duration and low-power long-duration radiofrequency ablation for atrial fibrillation. Anatol J Cardiol. 2022; 26(1): 2-14

Corresponding Author: Dibbendhu Khanra
Manuscript Language: English