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Meta-analysis of high power short duration in atrial fibrillation ablation – a superior efficient ablation strategy
Acta Cardiologica ( IF 1.6 ) Pub Date : 2021-07-05 , DOI: 10.1080/00015385.2021.1939512
Min Xu 1 , Yan Yang 1 , Dayong Zhang 1 , Weifeng Jiang 2
Affiliation  

Abstract

Background

The high power short duration (HPSD) approach was hoped to further improve the efficacy and safety in radiofrequency ablation of atrial fibrillation (AF), compared with Low power long duration (LPLD). However, the conclusion was controversial based on the previous limited data. The aim of this meta-analysis was to evaluate whether the clinical benefits of HPSD are superior to that of LPLD.

Methods

The PubMed, OVID, the Cochrane Library, and Elsevier’s ScienceDirect databases were searched for clinical studies to compare HPSD and LPLD approach by simple search strings benefiting to a wider screened scope.

Results

Fifteen trials with 3255 patients were included in this analysis. Pooled analyses suggested that HPSD was associated with a lower recurrence of atrial tachyarrhythmias (ATAs) at 1-year follow-up (OR: 0.49; 95% CI: 0.35 to 0.67, p < .0001), benefitted from AF recurrence reduced (OR: 0.46; 95% CI: 0.31 to 0.67, p < .0001), rather than atrial tachycardia/atrial flutter (AT/AFL), but similar at 6 months follow-up, with a decreased oesophageal thermal injury (ETI) (OR: 0.48; 95% CI: 0.30 to 0.77, p = .002). Meanwhile, the HPSD approach benefitted to increase first-pass pulmonary vein isolation (FPI) (OR: 0.47; 95% CI: 0.34 to 0.64, p < .00001) and decrease acute pulmonary vein re-isolation (PVR) (OR: 0.45; 95% CI: 0.35 to 0.58, p < .00001), both mainly embodied in left pulmonary veins (PVs). HPSD showed a decreased procedural time (SMD: −0.95; 95% CI: −1.06 to −0.85, p < .00001), ablation number for pulmonary vein isolation (PVI) (SMD: −0.41; 95% CI: −0.58 to −0.24, p < .00001) and fluoroscopy time (SMD: −0.22; 95% CI: −0.32 to −0.12, p < .0001), which benefits from PVI + additional ablation strategy (SMD: −0.33; 95% CI: −0.46 to −0.21, p < .0001).

Conclusions

The HPSD approach was associated with decreasing post-ablation AF recurrence in the 1-year follow-up, ETI, acute PVR (increasing FPI correspondingly), procedural time, ablation number for PVI and fluoroscopy time, benefitted to improve clinical outcomes and procedural process with improved safety.



中文翻译:

房颤消融中高功率短时程的荟萃分析——一种高效的消融策略

摘要

背景

与低功率长时程(LPLD)相比,高功率短时程(HPSD)方法有望进一步提高射频消融房颤(AF)的疗效和安全性。然而,基于先前有限的数据,该结论存在争议。这项荟萃分析的目的是评估 HPSD 的临床益处是否优于 LPLD。

方法

在 PubMed、OVID、Cochrane 图书馆和 Elsevier 的 ScienceDirect 数据库中搜索临床研究,以通过简单的搜索字符串比较 HPSD 和 LPLD 方法,从而扩大筛选范围。

结果

该分析包括 15 项试验,共 3255 名患者。汇总分析表明,HPSD 与 1 年随访时房性快速性心律失常 (ATA) 的复发率较低相关(OR:0.49;95% CI:0.35 至 0.67,p  < .0001),受益于 AF 复发率降低(OR : 0.46; 95% CI: 0.31 to 0.67, p  < .0001),而不是房性心动过速/房扑 (AT/AFL),但在 6 个月的随访中相似,食管热损伤 (ETI) 减少 (OR :0.48;95% CI:0.30 至 0.77,p  = .002)。同时,HPSD 方法有利于增加首过肺静脉隔离 (FPI) (OR: 0.47; 95% CI: 0.34 to 0.64, p  < .00001) 并减少急性肺静脉再隔离 (PVR) (OR: 0.45) ; 95% CI:0.35 至 0.58,p  < .00001),两者都主要体现在左肺静脉 (PV)。HPSD 显示手术时间缩短(SMD:-0.95;95% CI:-1.06 至 -0.85,p  < .00001),肺静脉隔离 (PVI) 的消融次数(SMD:-0.41;95% CI:-0.58 至-0.24,p  < .00001)和透视时间(SMD:-0.22;95% CI:-0.32 至 -0.12,p  < .0001),这得益于 PVI + 额外消融策略(SMD:-0.33;95% CI : -0.46 至 -0.21, p  < .0001)。

结论

HPSD 方法与 1 年随访中减少消融后 AF 复发、ETI、急性 PVR(相应地增加 FPI)、手术时间、PVI 消融次数和透视时间相关,有利于改善临床结果和手术过程提高安全性。

更新日期:2021-07-05
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