Comparison of
            high‐power
            short‐duration and
            low‐power long‐duration
            radiofrequency ablation for treating atrial fibrillation: Systematic review and
            meta‐analysis

Introduction: Different results are described after atrial fibrillation ablation and multiples predictors of recurrence are well established. Objective: Evaluate and analyze if first-pass isolation effect (FPI) during first atrial fibrillation (AF) ablation with high-power short-duration (HPSD) comparing to low-power long-duration (LPLD) can impact on late outcome. Methods: Observational, retrospective study, 144 patients submitted to HPSD and LPLD ablation. HPSD: 71 patients, 50 (70.42%) males, mean age 59.73 years, 52 (73.24%) hypertension, 44 (61.97%) obstructive apnea, 23 (32.39%) arterial disease, 20 (28.17%) diabetes, and 10(14.08%) stroke. CHADS2VASC2 2.57. CT: 73 patients, 50 (68.49%) males, mean age 60.7 years, 53 (72.60%) hypertension, 41 (56.16%) obstructive apnea, 28 (38.36%) arterial disease, 14 (19.17%) diabetes and 8 (10.96%) stroke. CHAD2SVASC2 2.22. Results: Recurrence occurred in 33 patients (22.92%) at 12 months follow-up, HPSD with 9 patients and LPLD with 24 patients. Higher rate of bilateral FPI were observed in HPSD patients with 62 of 71 patients comparing to 17 of 73 patients in LPLD (P < 0.00001). At the end of study 62 (87.32%) of 71 HPSD patients were in sinus rhythm comparing to 49 (67.12%) of 73 patients in LPLD (P 0.0039). Conclusion: HPSD ablation produced higher rates of FPI comparing to LPLD. HPSD compared to LPLD showed a superiority in maintaining sinus rhythm at 12 months. At patients submitted to HPSD protocol ablation, FPI could predict higher rate of sinus rhythm at 12 months follow-up.

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Use of contact force sensing technology during radiofrequency ablation reduces recurrence of atrial fibrillation: A systematic review and meta-analysis

Heart Rhythm ◽

10.1016/j.hrthm.2015.06.026 ◽

2015 ◽

Vol 12 (9) ◽

pp. 1990-1996 ◽

Cited By ~ 50

Author(s):

Muhammad R. Afzal ◽

Jawaria Chatta ◽

Anweshan Samanta ◽

Salman Waheed ◽

Morteza Mahmoudi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Radiofrequency Ablation ◽

Contact Force ◽

Meta Analysis ◽

Force Sensing ◽

Sensing Technology

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Abstract 12970: High Power Short Duration and Low Power Long Duration in Atrial Fibrillation Ablation: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.142.suppl_3.12970 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jakrin Kewcharoen ◽

Chol Techorueangwiwat ◽

Chanavuth Kanitsoraphan ◽

Thiratest Leesutipornchai ◽

Wasawat Vutthikraivit ◽

...

Keyword(s):

Atrial Fibrillation ◽

Low Power ◽

High Power ◽

Injury Risk ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Esophageal Injury ◽

Procedure Time ◽

Case Control Studies ◽

Large Populations

Background: Although high power, shorter duration (HPSD) ablation and low power, longer duration (LPLD) ablation strategies for atrial fibrillation (AF) are frequently advocated to enhance safety and efficacy, there exists a need for comparative data from large populations. We performed a meta-analysis to compare arrhythmia-free survival, procedure time and complications rates between the two strategies. Methods: We searched the databases of MEDLINE and EMBASE from inception to April 2020. Included studies were case-control studies, cohort studies, or randomized controlled trials that compared patients undergoing HPSD and LPLD strategies for AF ablation and reported either of the following outcomes: freedom from atrial tachyarrhythmia (AT) including AF and atrial flutter, procedure time, or periprocedural complications. Data from each study were combined using the random-effects model to calculate odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI). Results: Ten studies from 2006 to 2020 involving 2,189 patients were included (1,350 patients underwent HPSD strategy and 839 patients underwent LPLD strategy). Both HPSD and LPLD strategies resulted in a similar freedom from AT at 12-month follow-up (OR=1.36, 95% CI:0.91-2.04, p=0.13, Figure 1A). HPSD strategy did result in a significant reduction in total procedure time (WMD=47.34, 95% CI:29.47-65.21, p<0.001, Figure 1B) compared to LPSD. HPSD wasn’t associated with reduction in esophageal ulcer/arterioesophageal fistula (OR=0.35, 95%CI=0.12-1.06, p=0.06) or pericardial effusion/cardiac tamponade (OR=0.96, 95%CI: 0.24-3.79, p=0.95) Conclusions: In this large meta-analysis both LPLD and HPSD are equally effective and safe. Although HPSD is often advocated to reduce esophageal injury, risk was similar between approaches. However, HPSD strategy significantly lowers procedure times.

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