Efficacy And Safety Of High-power Short-duration Radiofrequency Ablation In The Treatment Of Atrial Fibrillation

Objective: Low-power long-duration(LPLD)and moderate power moderate duration(MPMD)catheter ablation are still the main ablation strategies for atrial fibrillation at present.In recent years,with the development of technologies such as pressure catheters,high-power short-duration catheter ablation(HPSD)has gradually entered people’s field of vision and applied clinically.However,whether there are differences in surgical complications and atrial arrhythmia recurrence rates between HPSD and MPMD ablation strategies remains to be confirmed.The primary objective of this study was to compare the clinical efficacy and safety of first-time HPSD ablation versus MPMD ablation in the treatment of atrial fibrillation.Methods: This study was a single-center,retrospective study.A total of450 patients with atrial fibrillation who underwent catheter radiofrequency ablation for the first time between February 2019 and April 2021 in the Second Hospital of Hebei Medical University were collected,including paroxysmal atrial fibrillation and persistent atrial fibrillation.To exclude confounding factors,1:1 propensity score matching was performed,and 132 patients were finally included: 91 patients in the 45-50 W high-power short-term ablation(HPSD)group and 91 patients in the 30-40 W moderate power moderate duration(MPMD)group.Baseline data(including age,gender,BMI,smoking history,drinking history,etc.),laboratory parameters,echocardiographic parameters,ablation data,and follow-up data were collected for all patients.Operation time,perioperative complications,recurrence of atrial tachyarrhythmia,and safety during follow-up were assessed between the two groups and subgroups.Result:1.Comparison of ablation time and operation time between HPSD group and MPMD group: Compared with MPMD group,the ablation time(37.34 ±9.40 vs 32.55 ± 7.39)and total operation time(183.07 ± 60.93 vs 152.57 ±52.22)of HPSD group were significantly shortened,all had significant statistical difference(P < 0.001).Subgroup analysis based on the type of atrial fibrillation,the total operation time and ablation time of the HPSD ablation group were significantly shorter than those of the MPMD ablation group,whether paroxysmal atrial fibrillation or persistent atrial fibrillation(P < 0.05).2.Comparison of postoperative recurrence between the HPSD group and the MPMD group: the average follow-up time was(18.01 ± 5.70)months,and the recurrence rates of atrial tachyarrhythmia in the HPSD and MPMD groups during the follow-up period were relatively 14.29%(13/91)and 23.08%(21/91).There was no significant difference in the overall arrhythmia recurrence rate between the two groups(overall,Log-rank P = 0.238).However,during the follow-up period,the recurrence rate of atrial fibrillation in the HPSD group was lower than that in the MPMD group(Log-rank P =0.047),Other events such as atrial flutter and atrial tachycardia were basically similar between the two groups.Subgroup analysis based on the type of atrial fibrillation,in patients with persistent atrial fibrillation(Log-rank P = 0.780)and patients with paroxysmal atrial fibrillation(Log-rank P = 0.254),there was no significant difference in postoperative atrial arrhythmia recurrence between the HPSD group and the MPMD group.Multivariate Cox regression analysis showed that degree of left atrial fibrosis(HR 1.021,95% CI1.006-1.036,P = 0.006)was independently associated with the recurrence of atrial tachyarrhythmia.3.Safety comparison between HPSD group and MPMD group: In the HPSD group,there were 7 patients(7.69%)with gas explosion(POP)during operation,2 patients(2.20%)with vagus nerve reflex,2 cases(2.20%)with hematoma at the puncture site,and 3 cases(3.30%)with gastroesophageal reflux and other gastrointestinal symptoms.In the MPMD group,5 cases(5.49%)of gas explosion(POP)occurred in the MPMD group,1 case(1.10%)of a small amount of pericardial effusion,and 1 case(1.10%)of vagus nerve Reflex,1 case(1.10%)of blood oozing at puncture site,gastroesophageal reflux and other gastrointestinal symptoms in 2 cases(2.20%).There was no statistical difference in the above complications and overall risk of complications between the two groups academic differences(P > 0.05).And there were no serious complications such as cardiac tamponade,atrial-esophageal fistula,diaphragm paralysis,esophageal injury,and stroke in both groups.Conclusion: Compared with traditional MPMD ablation,HPSD ablation can significantly reduce the overall operation time and ablation time,and there is no significant difference in perioperative complications and overall atrial tachyarrhythmia recurrence rates between the two ablation methods.However,during follow-up,HPSD ablation has advantages in reducing AF recurrence compared with MPMD ablation strategies.Therefore,HPSD ablation is considered a recommended ablation strategy in terms of ablation safety and efficiency.