High-Power, Short-Duration Versus Conventional Radiofrequency Ablation in AF

Recently, high-power, short-duration (HPSD) strategies in radiofrequency ablation for atrial fibrillation (AF) have been shown to improve outcomes, according to Mohan Li and colleagues. Via meta-analysis, they evaluated the safety and efficacy of HPSD versus conventional settings and concluded that HPSD radiofrequency ablation demonstrated better effectiveness and consistent safety.

The analysis, published in Cardiovascular Therapeutics, reviewed 22 studies from the PubMed, Embase, and Cochrane Library databases that encompassed 3867 patients with AF. Of those patients, 2393 underwent HPSD radiofrequency ablation.

Efficacy, safety, and effectiveness end points included first-pass pulmonary vein isolation (PVI), acute pulmonary vein (PV) reconnection, freedom from AF and atrial tachycardia during follow-up, esophagus injury rate, major complication rate, complete PVI rate, total procedure time, PVI time, and PVI radiofrequency ablation (PVI RF) time.

High-Power, Short-Duration Radiofrequency Ablation Versus Conventional Settings

Reportedly, patients who received HPSD ablation had a higher perioperative first-pass PVI rate (risk ratio [RR], 1.10; P=.0001) and lower acute PV reconnection rate (RR, 0.56; P=.0004) compared with the conventional group.

In follow-up, the proportion of patients with freedom from AF (RR, 1.11; P=.16) and atrial tachycardia (RR, 1.11; P<.0001) in both groups was similar at 6 months. However, the HPSD group had higher freedom from AF (RR, 1.17; P=.0003) and atrial tachycardia (RR, 1.11; P<.0001) at 12 months.

For safety end points, the rates of esophagus injury (RR, 0.99; P=.98) and major complications (RR, 0.76; P=.70) did not differ between the 2 groups. For effectiveness end points, the authors found HPSD had shorter total procedure time (mean difference [MD], -33.71; 95% CI, -43.10 to -24.33; P<.00001), PVI time (MD, -21.60; 95% CI, -25.00 to -18.21; P<.00001), and PVI RF time (MD, -13.72; 95% CI, -14.45 to -13.00; P<.00001) compared with the conventional settings. Complete procedure rate was comparable between the 2 groups (RR, 1.00; P=.93).

According to the authors, their findings support further exploration and implementation of HPSD settings in radiofrequency ablation to improve clinical outcomes for patients with atrial fibrillation.

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