Nanjing Medical University Affiliated Hangzhou First People's Hospital, Nanjing, Jiangshu Province, China.
Department of Cardiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang Province, China.
Int J Clin Pract. 2021 Apr;75(4):e13732. doi: 10.1111/ijcp.13732. Epub 2020 Nov 30.
Radiofrequency ablation in patients with atrial fibrillation (AF) is effective but hampered by pulmonary veins reconnection because of insufficient lesions. High power shorter duration ablation (HPSD) was seen to increase efficacy and safety. This analysis aimed to evaluate the clinical benefits of HPSD in patients with AF.
The Medline, PubMed, Embase, and the Cochrane Library databases were searched for studies comparing HPSD and Low power longer duration (LPLD) ablation.
A total of seven trials with 2023 patients were included in the analysis. Pooled analyses demonstrated that HPSD showed a benefit of first-pass pulmonary vein isolation (PVI) [risk ratio (RR): 1.27; 95% confidence interval (CI): 1.18-1.37, P < .001]. HPSD could reduce recurrence of atrial arrhythmias (RR: 0.70; 95% CI: 0.50-0.98, P = .04). Additionally, HPSD was more beneficial in terms of procedural time [Weighted Mean Difference, (WMD): -44.62; 95% CI, -63.00 to -26.23, P < .001], ablation time (WMD: -21.25; 95% CI: -25.36 to -17.13, P < .001), and fluoroscopy time (WMD: -4.13; 95% CI: -7.52 to -0.74, P < .001). Moreover, major complications and esophageal thermal injury (ETI) were similar between two groups (RR: 0.75; 95% CI: 0.44-1.30, P = .31) and (RR: 0.64; 95% CI: 0.17-2.39, P = .51).
HPSD was safe and efficient for treating AF with clear advantages of procedural features, it also showed benefits of higher first-pass PVI and reducing recurrence of atrial arrhythmias compared with the LPLD. Moreover, major complications and ETI were similar between two groups.
射频消融术治疗心房颤动（AF）有效，但由于病灶不足，肺静脉再通阻碍了其疗效。高功率短时间消融（HPSD）被认为可以提高疗效和安全性。本分析旨在评估 HPSD 治疗 AF 患者的临床获益。
检索 Medline、PubMed、Embase 和 Cochrane 图书馆数据库，比较 HPSD 和低功率长时间消融（LPLD）的研究。
共纳入 7 项共 2023 例患者的试验进行分析。汇总分析表明，HPSD 可提高首次通过肺静脉隔离（PVI）的效果[风险比（RR）：1.27；95%置信区间（CI）：1.18-1.37，P<.001]。HPSD 可降低房性心律失常的复发率（RR：0.70；95%CI：0.50-0.98，P=0.04）。此外，在手术时间[加权均数差（WMD）：-44.62；95%CI：-63.00 至-26.23，P<.001]、消融时间（WMD：-21.25；95%CI：-25.36 至-17.13，P<.001）和透视时间（WMD：-4.13；95%CI：-7.52 至-0.74，P<.001）方面，HPSD 更具优势。此外，两组之间主要并发症和食管热损伤（ETI）的发生率相似（RR：0.75；95%CI：0.44-1.30，P=0.31）和（RR：0.64；95%CI：0.17-2.39，P=0.51）。
HPSD 治疗 AF 安全有效，具有明显的手术特点优势，与 LPLD 相比，HPSD 可提高首次 PVI 成功率，降低房性心律失常复发率。此外，两组之间主要并发症和 ETI 的发生率相似。
