Combined ablation with PWI plus PVI did not significantly reduce clinical AF recurrence compared to PVI alone (RR 0.86; 95% CI 0.70-1.06), but significantly increased total procedure duration.
Meta-Analysis (n=1,534)
Does adding posterior left atrial wall isolation (PWI) to traditional pulmonary vein isolation (PVI) reduce the recurrence of atrial fibrillation in patients with AF?
Adding posterior wall isolation to pulmonary vein isolation does not significantly reduce the overall recurrence of clinical AF but increases procedure duration, although specific techniques like cryoballoon may offer benefits.
Effect estimate: RR 0.86 (95% CI 0.70-1.06)
OBJECTIVE: Posterior left atrial wall isolation (PWI) plus traditional pulmonary vein isolation (PVI) has been proposed as a promising intervention to decrease atrial fibrillation (AF) recurrence. We aim to investigate the efficacy and safety of adding PWI to the traditional PVI in patients with AF. METHODS: A systematic review and meta-analysis was conducted using synthesizing randomized controlled trials (RCTs) retrieved by systematically searching PubMed, Web of Science, SCOPUS, EMBASE, and Cochrane through June 14, 2023. We used Stata version 17 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), with a 95% confidence interval (CI) (PROSPERO ID: CRD42023446227). RESULTS: We included 11 RCTs with a total number of 1534 patients. Combined ablation with PWI + PVI was not associated with any significant difference over PVI only regarding the recurrence of clinical AF (RR: 0.86 with 95% CI 0.70-1.06), all atrial arrhythmia (RR: 0.93 with 95% CI 0.82-1.07), nonatrial fibrillation arrhythmia (RR: 1.22 with 95% CI 0.97-1.53), early AF (RR: 0.89 with 95% CI 0.62-1.27), and antiarrhythmic drugs at discharge (RR: 0.83 with 95% CI 0.67-1.04). However, it was associated with increased total ablation duration (minutes) (MD: 12.58 with 95% CI 6.80-18.37) and total procedure duration (minutes) (MD: 16.77 with 95% CI 9.63-23.91), without any significant difference regarding adverse events (RR: 1.05 with 95% CI 0.63-1.74). CONCLUSION: While the pooled data from PWI + PVI using point-by-point radiofrequency did not suggest a benefit in the recurrence of various atrial arrhythmias compared to PVI alone, PWI+PVI using direct posterior wall ablation, especially with cryoballoon, demonstrated a significant reduction in recurrence of AF/atrial arrhythmias. Also, PWI + PVI significantly increased the ablation and total procedure durations.
Ibrahim et al. (Fri,) conducted a meta-analysis in Atrial fibrillation (n=1,534). Posterior left atrial wall isolation (PWI) plus pulmonary vein isolation (PVI) vs. Pulmonary vein isolation (PVI) only was evaluated on Recurrence of clinical AF (RR 0.86, 95% CI 0.70-1.06). Combined ablation with PWI plus PVI did not significantly reduce clinical AF recurrence compared to PVI alone (RR 0.86; 95% CI 0.70-1.06), but significantly increased total procedure duration.
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