Contact force-guided ablation for atrial flutter significantly reduced the need for touch-up ablation (RR 0.57) and radiofrequency duration, but did not improve long-term recurrence rates.
Meta-Analysis (n=761)
Yes
Does contact force related parameter-guided ablation improve procedural efficiency and clinical outcomes compared to conventional parameter-guided ablation in patients with CTI-dependent atrial flutter?
Contact force-guided ablation for CTI-dependent atrial flutter improves procedural efficiency and catheter-tissue contact but does not significantly alter long-term recurrence or safety compared to conventional methods.
Effect estimate: RR 0.57 (95% CI 0.39-0.84)
Absolute Event Rate: 16.6% vs 24.9%
p-value: p=0.004
Background Contact force (CF) and related parameters have been evaluated as an effective guide mark for pulmonary vein isolation, yet not for linear ablation of the cavotricuspid isthmus (CTI) dependent atrial flutter (AFL). We thus studied the efficacy and safety of CF related parameter-guided ablation for CTI-AFL. Methods Systematic search was performed on databases involving PubMed, EMbase, Cochrane Library and Web of Science (through June 2022). Original articles comparing CF related parameter-guided ablation and conventional parameter-guided ablation for CTI-AFL were included. One-by-one elimination, subgroup analysis and meta-regression were used for heterogeneity test between studies. Results Ten studies reporting on 761 patients were identified after screening with inclusion and exclusion criteria. Radiofrequency (RF) duration was significantly shorter in CF related parameter-guided group ( p = 0.01), while procedural time ( p = 0.13) and fluoroscopy time ( p = 0.07) were no significant difference between two groups. CF related parameter-guided group had less RF lesions ( p = 0.0003) and greater CF of catheter-tissue ( p = 0.0002). Touch-up needed after first ablation line was less in CF related parameter-guided group ( p = 0.004). In addition, there were no statistical significance between two groups on acute conduction recovery rates ( p = 0.25), recurrence rates ( p = 0.92), and complication rates ( p = 0.80). Meta-regression analysis revealed no specific covariate as an influencing factor for above results ( p 0.10). Conclusion CF related parameters guidance improves the efficiency of CTI ablation, with the better catheter-tissue contact, the lower RF duration and the comparable safety as compared with conventional method, but does not improve the acute success rate and long-term outcome.
Pang et al. (Fri,) conducted a meta-analysis in Cavotricuspid isthmus dependent atrial flutter (n=761). Contact force related parameter-guided ablation vs. Conventional parameter-guided ablation was evaluated on Touch-up needed after first ablation line (RR 0.57, 95% CI 0.39-0.84, p=0.004). Contact force-guided ablation for atrial flutter significantly reduced the need for touch-up ablation (RR 0.57) and radiofrequency duration, but did not improve long-term recurrence rates.