Comparative efficacy and safety profile of high-power short duration with low power long duration radiofrequency ablation in atrial fibrillation: An updated systematic review and meta-analysis

Background: High power short duration (HPSD) radiofrequency ablation was expected to be more effective and safer than low power long duration (LPLD) in treating atrial fibrillation (AF). Given the limited data, the findings were controversial. This meta-analysis evaluated whether HPSD’s clinical effects outweigh LPLD’s. Methods: : A systematic search of PubMed, EMBASE, and Google Scholar databases identified studies comparing HPSD to LPLD ablation. All the analyses used the random-effects model. Results: : This analysis included 21 studies with a total of 4169 patients. Pooled analyses revealed that HPSD was associated with a lower recurrence of atrial tachyarrhythmias (ATAs) at one year (RR: 0.62; 95% CI: 0.50 to 0.78, p: 0.00001, I 2 : 0%). Furthermore, the HPSD approach reduced the risk of AF recurrence (RR: 0.64; 95% CI: 0.40 to 1.01, p: 0.06, I 2 : 86%), The HPSD approach was associated with a lower risk of esophageal thermal injury (ETI) (RR: 0.78; 95% CI: 0.58 to 1.04, p: 0.09, I 2 : 73%;). The HPSD strategy increased first-pass pulmonary vein isolation (FPI) and decreased acute pulmonary vein re-connection (PVR) both of which were predominantly manifested in bilateral and left pulmonary veins (PVs). HPSD demonstrated a reduction in procedural time, ablation number for pulmonary vein isolation (PVI), and fluoroscopy time. Conclusion: The HPSD method reduces ETI, PV reconnection, and recurrent AF. The HPSD approach also reduced procedural time, PVI ablation number, fluoroscopy time, and post-ablation AF relapse in one year, improving patient outcomes and safety.