Related Experiment Video
Updated: May 26, 2026
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
High-power, very-high-power, and low-power radiofrequency ablation for atrial fibrillation: A Bayesian network
Eduardo Celentano1,2, Ernesto Cristiano1,3, Barbara Ignatiuk1
1Electrophysiology Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy.
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.
