Pavani Peddi, Olanrewaju Olusegun Abiola, Sagar Raja Subhash, Bai Monika, Chand Jai, Bhatia Vishal, Sagar Fnu, Karishma Fnu, Islam Hamza, Kumar Aman, Versha Fnu, Islam Rabia, Nadeem Taha
Department of Surgery, Kurnool Medical College, Kurnool, India.
Department of Medicine, Stavropol State Medical University, Stavropol, Russia.
J Innov Card Rhythm Manag. 2024 Aug 15;15(8):5963-5980. doi: 10.19102/icrm.2024.15083. eCollection 2024 Aug.
Atrial fibrillation (AF) affects around 33 million people worldwide, rendering it a common cardiac arrhythmia. Catheter ablation (CA) has evolved as a leading therapeutic intervention for symptomatic AF. This umbrella review systematically evaluates existing systematic reviews and meta-analyses to assess the safety, efficacy, and potential of high-power, short-duration (HPSD) ablation as an alternative therapy option for AF. A thorough exploration was undertaken across PubMed, the Cochrane Library, and Embase to identify pertinent studies for inclusion in this umbrella review. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method was employed to assess the overall certainty of the evidence comprehensively, and the quality of the incorporated reviews was meticulously evaluated through use of the AMSTAR 2 tool, the Cochrane Collaboration tool, and the Newcastle-Ottawa scale. In this study, we initially identified 35 systematic reviews and meta-analyses, narrowing them down to a final selection of 11 studies, which collectively integrated data from 6 randomized controlled trials and 26 observational studies. For primary efficacy outcomes, the HPSD approach led to a non-significant decrease in the risk of atrial tachyarrhythmia recurrence (risk ratio [RR], 0.88; 95% confidence interval [CI], 0.70-1.12; = 90%; = .31) and a significantly reduced risk of AF recurrence (RR, 0.53; 95% CI, 0.42-0.67; = 0%; < .00001) compared to the low-power, long-duration (LPLD) approach. In terms of primary safety outcomes, the HPSD approach significantly reduced the risk of esophageal thermal injury (ETI) (RR, 0.71; 95% CI, 0.61-0.83; = 0%; < .00001) and facilitated a non-significant decrease in the risk of other major complications (RR, 0.87; 95% CI, 0.73-1.03; = 0%; = .10). In conclusion, HPSD therapy is safer and more effective than LPLD therapy, facilitating decreased AF recurrence rates along with reductions in ETI, total procedure duration, ablation number, ablation time, fluoroscopy time, and acute pulmonary vein reconnection.
心房颤动（AF）在全球约影响3300万人，使其成为一种常见的心律失常。导管消融（CA）已发展成为有症状AF的主要治疗干预手段。本伞状综述系统评价现有系统评价和荟萃分析，以评估高功率、短程（HPSD）消融作为AF替代治疗方案的安全性、有效性及潜力。通过全面检索PubMed、Cochrane图书馆和Embase来确定纳入本伞状综述的相关研究。采用推荐分级评估、制定与评价（GRADE）方法全面评估证据的总体确定性，并通过使用AMSTAR 2工具、Cochrane协作工具和纽卡斯尔-渥太华量表对纳入综述的质量进行细致评估。在本研究中，我们最初识别出35项系统评价和荟萃分析，最终筛选出11项研究，这些研究共整合了6项随机对照试验和26项观察性研究的数据。对于主要疗效结局，与低功率、长程（LPLD）方法相比，HPSD方法使房性快速心律失常复发风险有非显著性降低（风险比[RR]，0.88；95%置信区间[CI]，0.70 - 1.12；I² = 90%；P = 0.31），且AF复发风险显著降低（RR，0.53；95% CI，0.42 - 0.67；I² = 0%；P < 0.00001）。在主要安全性结局方面，HPSD方法显著降低了食管热损伤（ETI）风险（RR，0.71；95% CI，0.61 - 0.83；I² = 0%；P < 0.00001），并使其他主要并发症风险有非显著性降低（RR，0.87；95% CI，0.73 - 1.03；I² = 0%；P = 0.10）。总之，HPSD治疗比LPLD治疗更安全、有效，有助于降低AF复发率，同时减少ETI、总手术时间、消融次数、消融时间、透视时间和急性肺静脉再连接。
