Comparative Analysis of Clinical Outcomes of High-power, Short-duration Ablation versus Low-power, Long-duration Ablation Strategy in Patients with Atrial Fibrillation: A Comprehensive Umbrella Review of Meta-analyses.

Autor:	Pavani P; Department of Surgery, Kurnool Medical College, Kurnool, India., Olanrewaju OA; Department of Medicine, Stavropol State Medical University, Stavropol, Russia., Sagar RS; Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan., Bai M; Department of Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan., Chand J; Department of Medicine, Khairpur Medical College, Khairpur, Pakistan., Bhatia V; Department of Medicine, Khairpur Medical College, Khairpur, Pakistan., Sagar F; Department of Medicine, Bahria University Medical and Dental College, Karachi, Pakistan., Karishma F; Department of Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan., Islam H; Department of Medicine, Punjab Medical College, Faisalabad, Pakistan., Kumar A; Department of Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan., Versha F; Department of Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan., Islam R; Department of Medicine, Punjab Medical College, Faisalabad, Pakistan., Nadeem T; Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
Jazyk:	angličtina
Zdroj:	The Journal of innovations in cardiac rhythm management [J Innov Card Rhythm Manag] 2024 Aug 15; Vol. 15 (8), pp. 5963-5980. Date of Electronic Publication: 2024 Aug 15 (Print Publication: 2024).
DOI:	10.19102/icrm.2024.15083
Abstrakt:	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; I 2 = 90%; P = .31) and a significantly reduced risk of AF recurrence (RR, 0.53; 95% CI, 0.42-0.67; I 2 = 0%; P < .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; I 2 = 0%; P < .00001) and facilitated a non-significant decrease in the risk of other major complications (RR, 0.87; 95% CI, 0.73-1.03; I 2 = 0%; P = .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. Competing Interests: The authors report no conflicts of interest for the published content. No funding information was provided. (Copyright: © 2024 Innovations in Cardiac Rhythm Management.)
Databáze:	MEDLINE
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