3.3 Primary pooled analysis
Total procedure duration was significantly shorter in the HPSD RFA group compared with conventional RFA group [MD -38.28 min (95% CI -47.08 to -29.49); P<0.001] (Figure 2, A). Compared with the conventional RFA group, total RF duration [MD -20.51 min (95% CI -25.96 to -15.06); P<0.001] (Figure 2, B) and total fluoroscopy duration [MD -5.19 min (95% CI -8.02 to -2.37); P<0.001] (Figure 2, C) were also significantly shorter in the HPSD RFA group. First-pass isolation (OR 8.92, 95% CI 2.40-33.09, P=0.001) (Figure 3, A) and freedom from atrial arrhythmia at one year (OR 1.48, 95% CI 1.12-1.94, P=0.005) (Figure 3, B) were significantly higher in the HPSD RFA group when compared with the conventional group. Acute PVR was significantly lower in the HPSD RFA group (OR 0.40, 95% CI 0.23-0.69, P<0.001) (Figure 3, C). There was no difference between the two groups regarding total complications (OR 0.95, 95% CI 0.72-1.25, P=0.71) (Figure 4, A). Among these studies, only four studies described PVR during redo procedures, and there was no difference in PVR between the two groups (OR 0.65, 95% CI 0.29-1.46, P=0.29) (Figure 4, B).
There was significant heterogeneity with I2>50% for the outcomes of procedure duration (93%), RF duration (98%), fluoroscopy duration (95%), first-pass isolation (81%), freedom from atrial arrhythmia (73%), and acute PVR (72%). All summary estimates from pooled analyses were made using a random-effects model rather than a fixed-effects model to reduce the influence of heterogeneity between studies. Sensitivity analysis demonstrated the robustness of the above results during the sequential exclusion of studies except first-pass isolation, freedom from atrial arrhythmia and acute PVR. Low heterogeneity following exclusion of one study30 based on the follow-up monitoring for recurrence of AF demonstrated (I2=0), two studies27,30based on freedom from atrial arrhythmia (I2=2%) and one study31 based on acute PVR (I2=0). In spite of reduced heterogeneity, there were no changes in the results of differences between two groups.