Background. High power shorter duration (HPSD) ablation may lead to safe and rapid lesion formation. However, the optimal radio frequency power to achieve the desired ablation index (AI) or lesion size index (LSI) is insubstantial. This analysis aimed to appraise the clinical safety and efficacy of HPSD guided by AI or LSI (HPSD-AI or LSI) in patients with atrial fibrillation (AF). Methods. The Medline, PubMed, Embase, Web of Science, and the Cochrane Library databases from inception to November 2020 were searched for studies comparing HPSD-AI or LSI and low power longer duration (LPLD) ablation. Results. Seven trials with 1013 patients were included in the analysis. The analyses verified that HPSD-AI or LSI revealed benefits of first-pass pulmonary vein isolation (PVI) (RR: 1.28; 95% CI: 1.05–1.56, P = 0.01) and acute pulmonary vein reconnection (PVR) (RR: 0.65; 95% CI: 0.48–0.88, P = 0.005) compared with LPLD. HPSD-AI or LSI showed higher freedom from atrial tachyarrhythmia (AT) (RR = 1.32, 95% CI: 1.14–1.53, P = 0.0002) in the subgroup analysis of studies with PVI ± (with or without additional ablation beyond PVI). HPSD-AI or LSI could short procedural time (WMD: −22.81; 95% CI, −35.03 to −10.60, P = 0.0003), ablation time (WMD: −10.80; 95% CI: −13.14 to −8.46, P < .00001), and fluoroscopy time (WMD: −7.71; 95% CI: −13.71 to −1.71, P = 0.01). Major complications and esophageal lesion in HPSD-AI or LSI group were no more than LDLP group (RR: 0.58; 95% CI: 0.20–1.69, P = 0.32) and (RR: 0.84; 95% CI: 0.43–1.61, P = 0.59). Conclusions. HPSD-AI or LSI was efficient for treating AF with shorting procedural, ablation, and fluoroscopy time, higher first-pass PVI, and reducing acute PVR and may increase freedom from AT for patients with additional ablation beyond PVI compared with LPLD. Moreover, complications and esophageal lesion were low and no different between two groups.

中文翻译：

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房颤消融中以消融指数或病灶大小指数为指导的高功率短时消融的安全性和有效性：系统评价和荟萃分析

背景。高功率短持续时间 (HPSD) 消融可能会导致安全和快速的病变形成。然而，实现所需消融指数 (AI) 或病灶大小指数 (LSI) 的最佳射频功率并不重要。该分析旨在评估由 AI 或 LSI（HPSD-AI 或 LSI）指导的 HPSD 在心房颤动 (AF) 患者中的临床安全性和有效性。方法。在 Medline、PubMed、Embase、Web of Science 和 Cochrane 图书馆数据库中搜索了从成立到 2020 年 11 月的比较 HPSD-AI 或 LSI 与低功率长持续时间 (LPLD) 消融的研究。结果. 分析中包括了 7 项试验，共 1013 名患者。分析证实，HPSD-AI 或 LSI 显示首过肺静脉隔离 (PVI)（RR：1.28；95% CI：1.05–1.56，P = 0.01）和急性肺静脉重新连接（PVR）（RR：0.65）的益处; 95% CI: 0.48–0.88, P = 0.005) 与 LPLD 相比。HPSD-AI 或 LSI 在 PVI ±（在 PVI 之外进行或不进行额外消融）研究的亚组分析中显示出更高的房性快速性心律失常 (AT)（RR = 1.32，95% CI：1.14–1.53，P = 0.0002）。HPSD-AI 或 LSI 可以缩短手术时间（WMD：-22.81；95% CI，-35.03 至 -10.60，P = 0.0003）、消融时间（WMD：-10.80；95% CI：-13.14 至 -8.46，P < .00001）和透视时间（WMD：-7.71；95% CI：-13.71 至 -1.71，P = 0.01）。HPSD-AI或LSI组主要并发症和食管病变均不超过LDLP组（RR：0.58; 95% CI：0.20–1.69，P = 0.32）和（RR：0.84；95% CI：0.43–1.61，P = 0.59）。结论。与 LPLD 相比，HPSD-AI 或 LSI 可有效治疗 AF，缩短程序、消融和透视时间、更高的首过 PVI 和降低急性 PVR，并且可能增加 PVI 以外额外消融患者的 AT 自由度。此外，并发症和食管病变较低，两组之间没有差异。