SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
This article is part of the Research TopicPrecision Strategies for Atrial Fibrillation: Diagnosis, Risk, and Treatment InnovationsView all 10 articles
High-power short-duration versus conventional catheter ablation for atrial fibrillation: a meta-analysis and trial sequential analysis of randomized controlled trials
Provisionally accepted
- Beijing Anzhen Nanchong hospital of Capital Medical University, Nanchong, China
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Background: High-power short-duration (HPSD) ablation has emerged as an alternative to traditional low-power long-duration (LPLD) ablation. However, the safety and efficacy of HPSD remain controversial. The aim of this study was to evaluate the effectiveness and safety of HPSD in the ablation treatment of atrial fibrillation (AF). Methods: Randomized controlled trials (RCTs) comparing HPSD and LPLD were retrieved from PubMed, Web of Science, EMBASE, and the Cochrane liarbry up to May 2025. Statistical analysis was performed using RevMan 5.4 software. The risk ratio (RR) was used as the effect size for dichotomous variables, and the mean and standard deviation were used as the effect sizes for continuous variables. Results: A total of 8 RCTs involving 1024 patients were included. HPSD was significantly associated with a reduction in total procedure time (MD, -20.33, 95%CI: [-30.46, -10.21], P< 0.0001), pulmonary vein isolation time (MD, -22.01, 95%CI: [-27.10, -16.95], P< 0.00001), radiofrequency time (MD, -10.38, 95%CI: [-12.47, -8.29], P< 0.00001) and AF recurrence (RR 0.51, 0.36-0.74, P=0.0004, I2=14%, P=0.32). However, there were no significant differences between HPSD and SPLD ablation in all atrial arrhythmias recurrence (RR 1.06, 0.75-1.49, P=0.74, I2=40%, P=0.15), the incidence of esophageal lesions (RR: 1.21, 95% CI [0.55, 2.64], P = 0.63), any complications (RR: 1.37, 95% CI [0.76, 2.45], P = 0.29), first pass LPV isolation (RR 0.96, 0.91-1.01, P=0.10, I2=47%, P=0.11) and first pass RPV isolation (RR 1.01, 0.69-1.48, P=0.97, I2=75%, P=0.003). Conclusion: Compared with LPLD ablation, HPSD ablation was significantly associated with a reduction in total procedure time, PVI time, and radiofrequency time. HPSD ablation did not increase the risk of complications compared with LPLD ablation, but it may be underpowered to HPSD versus LPLD in patients with atrial fibrillation detect rare adverse events, necessitating additional large-scale RCTs to validate the safety profile of HPSD.
Keywords: high-power short-duration ablation, low-power long-duration ablation, AtrialFibrillation, randomized controlled trials, Meta-analysis
Received: 11 Sep 2025; Accepted: 24 Nov 2025.
Copyright: © 2025 He, He, Zhang, Hu, Cao, Wang, Zhao and Zhong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jing-Hng Zhao, a18145036811@163.com
Peng-Yu Zhong, zhongpengyu_lzu@126.com
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