Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 2;37(4):975-989.
doi: 10.1002/joa3.12590. eCollection 2021 Aug.

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

Yoga Waranugraha  1   2 , Ardian Rizal  1   2 , Achmad J Firdaus  1   2 , Fransiska A Sihotang  1   2 , Akita R Akbar  1   2 , Defyna D Lestari  1   2 , Muhammad Firdaus  1   2 , Akhmad I Nurudinulloh  1   2
Affiliations

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

Yoga Waranugraha et al. J Arrhythm. .

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.

Keywords: atrial fibrillation; catheter ablation; high‐power short duration; low‐power long‐duration; meta‐analysis.

PubMed Disclaimer

Conflict of interest statement

All authors declare no conflict of interest regarding the publication of this article.

Figures

FIGURE 1
FIGURE 1
Flow diagram showing study selection process
FIGURE 2
FIGURE 2
Forest plot of procedural parameters. (A) Procedure time; (B) Fluoroscopy time; and (C) Ablation time. CI, confidence interval; HPSD, high‐power short‐duration; IV, inverse variance; LPLD, low‐power long‐duration; SD, standard difference
FIGURE 3
FIGURE 3
Forest plot of the safety outcomes. (A) Esophageal thermal injury; (B) Pericardial effusion or cardiac tamponade; and (C) Phrenic nerve paralysis. CI, confidence interval; HPSD, high‐power short‐duration; LPLD, low‐power long‐duration; M‐H, Mantel‐Haenszel
FIGURE 4
FIGURE 4
Forest plot of the short‐term efficacy outcomes. (A) First‐pass pulmonary vein isolation and (B) Pulmonary vein reconnection. CI, confidence interval; HPSD, high‐power short‐duration; LPLD, low‐power long‐duration; M‐H, Mantel‐Haenszel
FIGURE 5
FIGURE 5
Forest plot of the long‐term efficacy outcomes. (A) Recurrent atrial fibrillation and (B) Recurrent atrial flutter or atrial tachycardia. CI, confidence interval; HPSD, high‐power short‐duration; LPLD, low‐power long‐duration; M‐H, Mantel‐Haenszel
See this image and copyright information in PMC

References

    1. Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L, et al. Catheter ablation for atrial fibrillation with heart failure. N Engl J Med. 2018;378:417–27. 10.1056/NEJMoa1707855 - DOI - PubMed
    1. Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Poole JE, et al. Effect of catheter ablation vs antiarrhythmic drug therapy on mortality, stroke, bleeding, and cardiac arrest among patients with atrial fibrillation: the CABANA randomized clinical trial. JAMA. 2019;321:1261–74. 10.1001/jama.2019.0693 - DOI - PMC - PubMed
    1. Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström‐Lundqvist C, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio‐Thoracic Surgery (EACTS). Eur Heart J. 2021;42:373–498. 10.1093/eurheartj/ehaa612 - DOI - PubMed
    1. Macle L, Frame D, Gache LM, Monir G, Pollak SJ, Boo LM. Atrial fibrillation ablation with a spring sensor‐irrigated contact force‐sensing catheter compared with other ablation catheters: systematic literature review and meta‐analysis. BMJ Open. 2019;9:e023775:10.1136/bmjopen-2018-023775 - DOI - PMC - PubMed
    1. Leshem E, Zilberman I, Tschabrunn CM, Barkagan M, Contreras‐Valdes FM, Govari A, et al. High‐power and short‐duration ablation for pulmonary vein isolation: biophysical characterization. JACC Clin Electrophysiol. 2018;4:467–79. 10.1016/j.jacep.2017.11.018 - DOI - PubMed