Department of Geriatrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Department of Cardiovascular Medicine, Second Xiangya Hospital, Central South University, Changsha 410011, China.
Cardiovasc Ther. 2022 Jul 29;2022:1065077. doi: 10.1155/2022/1065077. eCollection 2022.
High-power short-duration (HPSD) setting during radiofrequency ablation has become an attempt to improve atrial fibrillation (AF) treatment outcomes. This study ought to compare the efficacy, safety, and effectiveness between HPSD and conventional settings. PubMed, Embase, and Cochrane Library were searched. Studies that compared HPSD and conventional radiofrequency ablation settings in AF patients were included while studies performed additional ablations on nonpulmonary vein targets without clear recording were excluded. Data were pooled with random-effect model. Efficacy endpoints include first-pass pulmonary vein isolation (PVI), acute pulmonary vein (PV) reconnection, free from AF, and free from atrial tachycardia (AT) during follow-up. Safety endpoints include esophagus injury rate and major complication rate. Effectiveness endpoints include complete PVI rate, total procedure time, PVI time, and PVI radiofrequency ablation (PVI RF) time. We included 22 studies with 3867 atrial fibrillation patients in total (2393 patients received HPSD radiofrequency ablation). Perioperatively, the HPSD group showed a higher first-pass PVI rate (risk ratio, RR = 1.10, = 0.0001) and less acute PV reconnection rate (RR = 0.56, = 0.0004) than the conventional group. During follow-up, free from AF (RR = 1.11, = 0.16) or AT (RR = 1.06, = 0.24) rate did not differ between HPSD and conventional groups 6-month postsurgery. However, the HPSD group showed both higher free from AF (RR = 1.17, = 0.0003) and AT (RR = 1.11, < 0.0001) rate than the conventional group 12-month postsurgery. The esophagus injury (RR = 0.99, = 0.98) and major complications (RR = 0.76, = 0.70) rates did not differ between the two groups. The HPSD group took shorter total procedure time (MD = -33.71 95% CI: -43.10 to -24.33, < 0.00001), PVI time (MD = -21.60 95% CI: -25.00 to -18.21, < 0.00001), and PVI RF time (MD = -13.72, 95% CI: -14.45 to -13.00, < 0.00001) than conventional groups while complete procedure rate did not differ between two groups (RR = 1.00, = 0.93). HPSD setting during AF radiofrequency ablation has better effectiveness, efficacy, and similar safety compared with the conventional setting.
高功率短时间（HPSD）设置在射频消融期间已成为改善心房颤动（AF）治疗结果的尝试。本研究旨在比较 HPSD 和常规设置之间的疗效、安全性和有效性。检索了 PubMed、Embase 和 Cochrane Library。纳入了比较 AF 患者中 HPSD 和常规射频消融设置的研究，排除了未明确记录的非肺静脉靶点进行额外消融的研究。使用随机效应模型汇总数据。疗效终点包括初次通过肺静脉隔离（PVI）、急性肺静脉（PV）再连接、随访时无 AF 和无房性心动过速（AT）。安全性终点包括食管损伤发生率和主要并发症发生率。有效性终点包括完全 PVI 率、总手术时间、PVI 时间和 PVI 射频消融（PVI RF）时间。我们共纳入了 22 项研究，共 3867 例 AF 患者（2393 例接受 HPSD 射频消融）。围手术期，HPSD 组初次通过 PVI 率更高（风险比，RR=1.10， =0.0001），急性 PV 再连接率更低（RR=0.56， =0.0004）。随访 6 个月时，HPSD 组和常规组的无 AF（RR=1.11， =0.16）或 AT（RR=1.06， =0.24）率无差异。然而，HPSD 组术后 12 个月无 AF（RR=1.17， =0.0003）和 AT（RR=1.11， <0.0001）率均高于常规组。两组食管损伤（RR=0.99， =0.98）和主要并发症（RR=0.76， =0.70）发生率无差异。HPSD 组总手术时间（MD=-33.71，95%CI：-43.10 至-24.33， <0.00001）、PVI 时间（MD=-21.60，95%CI：-25.00 至-18.21， <0.00001）和 PVI RF 时间（MD=-13.72，95%CI：-14.45 至-13.00， <0.00001）均短于常规组，而两组完全手术成功率无差异（RR=1.00， =0.93）。与常规设置相比，AF 射频消融期间的 HPSD 设置具有更好的疗效、效果和相似的安全性。
