Left atrial appendage electrical isolation significantly improved freedom from all-atrial arrhythmia recurrence compared to standard ablation alone (69.3% vs 46.4%; RR 0.54; 95% CI 0.42-0.69; P<0.0001).
Meta-Analysis (n=2,336)
Does left atrial appendage electrical isolation improve freedom from all-atrial arrhythmia recurrence in patients with non-paroxysmal atrial fibrillation undergoing catheter ablation?
Left atrial appendage electrical isolation during catheter ablation for non-paroxysmal atrial fibrillation significantly improves long-term freedom from atrial arrhythmia recurrence without increasing procedural complications or stroke risk.
Relative Risk: 0.54 (95% CI 0.42–0.69)
Tasa de eventos absoluta: 69.3% vs 46.4%
Reducción absoluta del riesgo: 22.9%
valor p: p=< 0.0001
AIMS: Left atrial appendage electrical isolation (LAAEI) has been shown to improve freedom from all-atrial arrhythmia recurrence in patients with non-paroxysmal atrial fibrillation (AF). The aim of this study is to investigate the long-term efficacy and safety outcomes of LAAEI in patients with non-paroxysmal AF undergoing catheter ablation. METHODS AND RESULTS: A systematic review of Medline, Cochrane, and Embase was performed for clinical studies evaluating the benefit of LAAEI in non-paroxysmal AF. Nine studies with a total of 2336 patients were included (mean age: 65 ± 9 years, 63% male). All studies included patients with persistent AF, long-standing persistent AF, or both. At a mean follow-up of 40.5 months, patients who underwent LAAEI had significantly higher freedom from all-atrial arrhythmia recurrence than patients who underwent standard ablation alone 69.3% vs. 46.4%; risk ratio (RR) 0.54; 95% confidence interval (CI) 0.42-0.69; P < 0.0001. A 46% relative risk reduction and 22.9% absolute risk reduction in atrial-arrhythmia recurrence was noted with LAAEI. Rates of cerebral thromboembolism were not significantly different between the two groups (LAAEI 3% vs. standard ablation 1.6%, respectively; RR 1.76; 95% CI 0.61-5.04; P = 0.29). Furthermore, there was no significant difference in the acute procedural complication rates between the two groups (LAAEI 4% vs. standard ablation 3%, respectively; RR 1.29; 95% CI 0.83-2.02; P = 0.26). CONCLUSION: At long-term follow-up, LAAEI led to a significantly higher improvement in freedom from all-atrial arrhythmia recurrence in patients with non-paroxysmal AF, when compared to standard ablation alone. Importantly, this benefit was achieved without an increased risk of acute procedural complications or cerebral thromboembolic events.
Romero et al. (Mon,) conducted a meta-analysis in Non-paroxysmal atrial fibrillation (n=2,336). Left atrial appendage electrical isolation (LAAEI) vs. Standard ablation alone was evaluated on Freedom from all-atrial arrhythmia recurrence (RR 0.54, 95% CI 0.42-0.69, p=< 0.0001). Left atrial appendage electrical isolation significantly improved freedom from all-atrial arrhythmia recurrence compared to standard ablation alone (69.3% vs 46.4%; RR 0.54; 95% CI 0.42-0.69; P<0.0001).