Efficacy and Safety of High-power Short-duration Radio Frequency Ablation in the Treatment of Atrial Fibrillation: A Meta-analysis of Prospective Study

Abstract

Background: Radiofrequency ablation is a critical therapeutic method used in the management of atrial fibrillation (AF). This study systematically evaluates the effectiveness and safety of two catheter radio frequency ablation approaches: high-power short-duration (HPSD) and traditional low-power long-duration (LPLD), in treating AF. Methods: Four databases were searched for prospective studies (eight cohort studies and three randomised controlled trials) that evaluated the effect of HPSD treatment on AF recurrence, occurrence rate of complications and procedural time in patients with AF from the establishment of the databases to March 2023. We utilised RevMan 5.20 and Stata 11.0 statistical software to conduct a meta-analysis, and publication bias was assessed using funnel plots and Egger's test. The effect estimates were synthesised as relative risks (RRs) or standardised mean differences (SMDs) along with their corresponding 95% confidence intervals (CIs). Results: A total of 536 relevant studies were retrieved, and 11 prospective studies were collected. The combined value of the estimated effect of HPSD versus LPLD treatment on AF recurrence in patients with AF had an RR of 0.59 (95% CI: 0.45–0.78; p < 0.001), the effects of HPSD versus LPLD treatment on procedural time in patients with AF had an SMD of –1.17 (95% CI: –1.56– –0.77; p < 0.001), and the effect of HPSD versus LPLD treatment on oesophageal thermal injury in patients with AF had an RR of 0.84 (95% CI: 0.22–3.28; p = 0.80). Notably, the estimated combined effects of HPSD and LPLD on other major complications (steam pop) in patients with AF had an RR of 0.57 (95% CI: 0.22–1.47; p = 0.24). Conclusions: HPSD is more effective than traditional LPLD and has a lower AF recurrence rate after surgery. Meanwhile, HPSD treatment can improve surgical efficiency and has a shorter procedural time than LPLD treatment.