System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Epublish

PubMed: 42183005 DOI: 10.1016/j.hroo.2026.02.018

High-power, very-high-power, and low-power radiofrequency ablation for atrial fibrillation: A Bayesian network meta-analysis.

Heart Rhythm O2 7(5):848-860

Authors: Eduardo Celentano, Ernesto Cristiano, Barbara Ignatiuk, Martina Renda, Anthea D'Amico, Elena Bia, Raffaele Rainone, Eduardo Urgesi, Giuseppe Grandinetti, Roberto Lorusso, Natasja M S De Groot

Affiliations

  • Electrophysiology Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy.
  • Translational Electrophysiology Unit, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
  • Electrophysiology Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy. Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
  • Electrophysiology Unit, Mater Dei Hospital, Bari, Italy.
  • Electrophysiology Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy. Electrophysiology Unit, Mater Dei Hospital, Bari, Italy.
  • Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.

Abstract

BACKGROUND

High-power short-duration (HPSD) and very-high-power short-duration (vHPSD) radiofrequency (RF) strategies have been proposed to improve lesion quality and procedural efficiency in atrial fibrillation ablation.

OBJECTIVE

This study aimed to compare HPSD, vHPSD, and low-power long-duration (LPLD) ablation by performing a systematic review and Bayesian network meta-analysis.

METHODS

Following Cochrane/Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidance, multiple databases were searched, and 51 studies (13,751 patients) were included. Consistent and unrelated-mean-effects models were fitted, inconsistency and design-by-treatment tests assessed coherence, and leave-one-out and Egger's analyses explored robustness and small-study effects. The primary outcome was atrial arrhythmia recurrence, and secondary outcomes included procedural safety (in-hospital complications) and efficiency parameters (procedure, fluoroscopy, and RF time). Treatment ranking was derived using the surface under the cumulative ranking curve.

RESULTS

Both HPSD and vHPSD reduced recurrence compared with LPLD (rate ratios [RR] 0.85; 95% credible interval [CrI] 0.75-0.96; and RR 0.79; 95% CrI 0.64-0.96, respectively), whereas the vHPSD vs HPSD comparison was inconclusive (RR 0.93; 95% CrI 0.75-1.13). Ranking suggested vHPSD as having the highest probability of being the better choice for procedural outcomes (79% vHPSD, 21% HPSD, 0% LPLD). Safety was comparable among RF strategies. Procedure and RF times were shorter with high-power approaches (approximately 34 minutes shorter); HPSD had the shortest fluoroscopy time (-7 minutes vs LPLD), and vHPSD had the shortest RF time (-24 minutes vs LPLD).

CONCLUSION

High-power RF strategies were associated with improved procedural efficiency and, in the overall evidence base, lower recurrence than conventional LPLD; however, recurrence benefit was mainly supported by observational evidence. Comparative safety showed no significant differences. Adequately powered randomized trials are warranted to clarify long-term outcomes and directly compare HPSD and vHPSD.

MeSH

Safety, Fluoroscopy, Atrial Fibrillation, Network Meta-Analysis, Radiofrequency Ablation