What question did this study set out to answer?

To evaluate the efficacy and safety of adding voltage-guided low-voltage area substrate modification to pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation.

January 5, 2017Pacing and Clinical Electrophysiology

Left Atrial Substrate Modification Targeting Low‐Voltage Areas for Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta‐Analysis

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Atrial fibrillation (n=885). Intervention: Voltage-guided substrate modification targeting low-voltage area (LVA) in addition to PVI vs. PVI alone and PVI + conventional wide empirical ablation. Primary outcome: Freedom from AF/atrial tachycardia (AT) recurrences (OR 3.41, 95% CI 2.22-5.24).

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Key result

Adding LVA ablation to PVI cuts AF/AT recurrences by ~47% versus PVI alone.

Why the study?

Does voltage-guided substrate modification targeting low-voltage areas in addition to PVI improve freedom from AF/AT recurrences in patients undergoing catheter ablation for AF?

Key Points

To evaluate the efficacy and safety of adding voltage-guided low-voltage area substrate modification to pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation.
Systematic review and meta-analysis of MEDLINE/PubMed, Cochrane Library, and reference lists identifying studies on voltage-guided substrate ablation for atrial fibrillation.
Included 6 studies comprising 885 patients (517 in the low-voltage area ablation group and 368 in the control group; median age 60 years, 92% nonparoxysmal atrial fibrillation; mean follow-up of 17 months).
Freedom from atrial fibrillation/atrial tachycardia recurrence at 17 months was significantly higher with low-voltage area ablation plus pulmonary vein isolation compared to controls (70% vs. 43%; OR = 3.41, 95% CI: 2.22–5.24), without significantly altering adverse event rates (2.5% vs. 6.0%; OR = 0.43, 95% CI: 0.15–1.26).
Compared to empirical wide ablation, targeting low-voltage areas significantly reduced post-ablation atrial tachycardia (14% vs. 46%; OR = 0.16, 95% CI: 0.07–0.37), procedure duration (176 vs. 220 min; OR = 0.36, 95% CI: 0.24–0.56), fluoroscopy time (25 vs. 31 min; OR = 0.22, 95% CI: 0.12–0.39), and radiofrequency delivery time (55 vs. 90 min; OR = 0.49, 95% CI: 0.27–0.90).

Study Design

Type

Meta-Analysis (n=885)

Structured PICO

Does voltage-guided substrate modification targeting low-voltage areas in addition to PVI improve freedom from AF/AT recurrences in patients undergoing catheter ablation for AF?

Population

885 patients undergoing catheter ablation for atrial fibrillation (AF) pooled from 6 studies. Median age 60 years; 92% had nonparoxysmal AF.

Intervention

Voltage-guided substrate modification targeting low-voltage area (LVA) in addition to pulmonary vein isolation (PVI)

Comparator

PVI alone or PVI + conventional wide empirical ablation

Outcome

Freedom from AF/atrial tachycardia (AT) recurrences at a mean follow-up of 17 monthscomposite

Main Result

Effect estimate: OR 3.41 (95% CI 2.22-5.24)

Absolute Event Rate: 70% vs 43%

Targeting low-voltage areas in addition to PVI during AF ablation significantly improves freedom from atrial arrhythmias without increasing adverse events compared to conventional approaches.

Authors

ABAlessandro BlandinoOspedali Riuniti Umberto I FBFrancesca BianchiMarche Polytechnic University SGStefano GrossiA. O. Ordine Mauriziano di Torino

Discussion

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Implication

Supports adding LVA ablation to PVI for higher AF/AT freedom; extends prior trial data via meta-analysis.

Cite This Study

Blandino et al. (2017) conducted a meta-analysis in Atrial fibrillation (n=885). Voltage-guided substrate modification targeting low-voltage area (LVA) in addition to PVI vs. PVI alone and PVI + conventional wide empirical ablation was evaluated on Freedom from AF/atrial tachycardia (AT) recurrences (OR 3.41, 95% CI 2.22-5.24). LVA ablation in addition to PVI increased freedom from AF/AT recurrences compared to PVI alone or with conventional ablation (70% vs. 43%; OR 3.41, 95% CI 2.22-5.24).

synapsesocial.com/papers/6a0ec29353f874f2b222bb03 https://doi.org/10.1111/pace.13015

Topics

Atrial fibrillation Persistent AF management AF ablation outcomes Anticoagulation in AF

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Left Atrial Substrate Modification Targeting Low‐Voltage Areas for Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta‐Analysis

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Left Atrial Substrate Modification Targeting Low‐Voltage Areas for Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta‐Analysis

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

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