Abstract 12639: Comparison of Very High-Power Short-Duration, High-Power Short-Duration, and Low-Power Long-Duration Radiofrequency Ablation for Atrial Fibrillation: A Systematic Review and Network Meta-Analysis

Abstract

Introduction: The optimal power and duration settings for radiofrequency (RF) atrial fibrillation (AF) ablation is unclear. We compared low-power long-duration (LPLD), high-power short-duration (HPSD), and very HPSD (vHPSD) settings for AF ablation. Hypothesis: Ablation utilizing HPSD and vHPSD are expected to have shorter procedural times than LPLD and may have improved arrhythmic outcomes. Aims: To compare LPLD, HPSD, and vHPSD ablation by network meta-analysis Methods: This network meta-analysis (NMA) was structured according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Observational and randomized studies were included. Eligible studies compared outcomes in AF patients who underwent first-time RF ablation with the following settings: vHPSD (70-90 Watts for 3-10 seconds), HPSD (45-60 W, 5-10 s), or LPLD (20-40 W, 20-60 s). Results: Thirty-six studies comprising 10375 patients were included (33% female). Frequentist NMA showed LPLD tended towards a lower odds of freedom from arrhythmia (FFA) vs. HPSD (OR 0.93, 95% CI 0.86-1.00). There was no difference in FFA between vHPSD vs. HPSD. Splitwise interval estimates showed a lower odds of FFA in LPLD vs. vHPSD on direct (OR 0.78, 95% CI 0.65-0.93) and network estimates (OR 0.85, 95% CI 0.73-0.98). Frequentist NMA showed less total procedural (TP) time with HPSD vs. LPLD (generic variance 1.06, 95% CI 0.83-1.29) and no difference between HPSD vs. vHPSD. Conclusion: This NMA shows improved procedural times in HPSD and vHPSD vs. LPLD. Although HPSD tended towards improved odds of FFA compared to LPLD, the result was not statistically significant. The odds of FFA in LPLD was lower vs. vHPSD on direct and network estimates on splitwise interval analysis. Randomized clinical trials are needed to validate HPSD and vHPSD settings.