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

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.