Safety and Efficacy of High Power Shorter Duration Ablation Guided by Ablation Index or Lesion Size Index in Atrial Fibrillation Ablation: A Systematic Review and Meta-Analysis.

Xing Liu,Guoqiang Zhong,Weiming Wen,Chun Gui,Yan He,Weiran Dai,Shenghua Zhou

doi:10.1155/2021/5591590

Abstract

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.

Highlights

Compared to medical therapies alone, catheter ablation has been identified as an effective treatment for atrial fibrillation (AF), and quality of life of patients was significantly improved [1]
Further 25 studies were excluded after a detailed assessment of the full text due to the following: 5, uncontrolled trials; 3, no outcome of interests; 2, reporting duplicate date; and 15, ablation not abided by ablation index (AI) or lesion size index (LSI)
Considering the high heterogeneity of the results, the subgroup analysis of different ablation strategies showed good homogeneity. e same conclusion was reached in the pulmonary vein isolation (PVI) ± subgroup, while freedom from AF/atrial tachyarrhythmia (AT) rate of High power shorter duration (HPSD)-AI or LSI was not more than LDLP among patients with undergoing only PVI, indicating that HPSD-AI or LSI may increase freedom from AT for patients with additional ablation beyond PVI compared with low power longer duration (LPLD). e possible reason is that HPSD-AI or LSI is superior than LPLD in improving the success rate of additional ablation beyond PVI and reducing the incidence of associated arrhythmias after radiofrequency ablation of AF

Summary

Introduction

Compared to medical therapies alone, catheter ablation has been identified as an effective treatment for atrial fibrillation (AF), and quality of life of patients was significantly improved [1]. High power primarily increases the effect of resistive heating, while ablation duration produces conductive heating. E 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. E 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 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. Complications and esophageal lesion were low and no different between two groups

Methods

Results

Discussion

Conclusion