Temperature-controlled ablation versus conventional ablation for pulmonary vein isolation in the treatment of atrial fibrillation: a systematic review and meta-analysis

Abstract

Background This study aims to compare the efficacy and safety of temperature-controlled and conventional contact-force sensing radiofrequency ablation catheters for pulmonary vein isolation (PVI) in atrial fibrillation (AF). Methods Seven studies (1138 patients) were included. Randomised controlled trials and observational (single-arm and two-arm) studies which reported freedom from AF >= 3 months after PVI with temperature-controlled radiofrequency ablation catheters (Biosense Webster QDOT MICRO operating in Q-MODE or Medtronic DiamondTemp) were included. Results Freedom from AF at a mean follow up of 9.0 +/- 3.6 months did not differ significantly between temperature-controlled and conventional ablation (OR = 1.22; 95% CI [-0.79 to 1.64]; p = 0.24). Total procedure duration (-13.5 minutes; 95% CI [-17.1 to -10.0]; p < 0.001) and total ablation duration (-8.9 minutes; 95% CI [-10.3 to -7.5]; p < 0.01) were significantly shorter for temperature-controlled ablation. No significant difference was found between the aggregated rates of procedural complications (OR = 0.69; 95% CI [-0.15 to 1.54]; p = 0.11) nor in the rate of any individual complication. Conclusion Temperature-controlled ablation was found to be at least noninferior to conventional ablation in all measures of efficacy and safety. Further randomised controlled trials are warranted to evaluate long-term rates of freedom from AF and patient comfort.