title: The impact of power output during percutaneous catheter radiofrequency ablation for atrial fibrillation on efficacy and safety outcomes: a systematic review.
abstract: BACKGROUND
  Percutaneous catheter radiofrequency ablation (RFA) has been widely used to treat patients with atrial fibrillation (AF). Success rates are, however, variable and optimal levels of power used and duration of power delivery have not been fully established. Different ablation centers continue to use various power protocols. We undertook a comprehensive systematic review to evaluate the impact of power output during RFA for AF on efficacy and safety.
  
  
  RESULTS
  We systematically searched MEDLINE and Cochrane Central Register of Controlled Trials databases for studies on power output during percutaneous RFA for AF. The marked heterogeneous nature of the studies prohibited a meta-analysis. The main findings were (1) power output of ≤30 watts (W) has good safety profiles but low efficacy rates; (2) power output of >30 W-<45 W is safe with good efficacy; (3) power output of ≥ 45 W has a better efficacy profile but associated with a high risk of complications; (4) delivery of higher power of ≥ 45 W at shorter duration (15-20 seconds) is safe and efficacious; and (5) energy titration with visualization of microbubbles by intracardiac echocardiography (ICE) has better efficacy and safety profiles compared to RFA without ICE.
  
  
  CONCLUSIONS
  Despite the overall reduced quality data relating power to outcomes of RFA for AF, the optimal power output showing good efficacy and safety profiles appears generically to be >30 W-<45 W, with significant variation in the literature.
authors.affiliation: Department of Cardiology, University Hospitals of Leicester, Glenfield Hospital, Leicester, UK; Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Yuyun
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Stafford
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Sandilands
authors.forename: Nilesh J
authors.initials: NJ
authors.lastname: Samani
authors.forename: G
authors.initials: G
authors.lastname: André Ng
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011211:Electric Power Supplies; D006801:Humans; D061214:Patient Safety; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: atrial fibrillation; efficacy; power output; radiofrequency ablation; safety