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September 15, 2009Circulation Arrhythmia and Electrophysiology

Pulmonary Vein Isolation for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation

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Why the study?

Does pulmonary vein isolation improve freedom from recurrent atrial fibrillation compared to medical therapy in patients with atrial fibrillation?

Population

6 RCTs pooling 693 patients with atrial fibrillation

Comparison

Pulmonary vein isolation (catheter ablation) vs Medical therapy (control)

Design

Meta-analysis, Randomized (meta-analysis of RCTs)

Follow-up

12 months

Key result

Pulmonary vein isolation significantly increased freedom from recurrent atrial fibrillation at 12 months compared with medical therapy (77% vs 29%; OR 9.74; 95% CI 3.98 to 23.87).

Authors

JPJonathan P. PicciniRLRenato D. LópesMKMelissa H. Kong

Discussion

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Overview

Supports prioritizing pulmonary vein isolation for rhythm control in atrial fibrillation; confirms benefit over medical therapy in Level 1 evidence.

Key Points

  • This research aims to evaluate the efficacy of pulmonary vein isolation (PVI) compared to medical therapy in maintaining sinus rhythm in patients with atrial fibrillation (AF).
  • Conducted a meta-analysis of 6 randomized controlled trials comparing PVI and medical therapy
  • Included a total of 693 patients with atrial fibrillation
  • Primary endpoint was freedom from recurrent AF at 12 months.
  • PVI showed 77% freedom from AF compared to 29% for medical therapy (odds ratio 9.74; 95% CI, 3.98 to 23.87)
  • Exclusion of one trial increased PVI's odds of AF-free survival to 15.78 (95% CI, 10.07 to 24.73)
  • PVI associated with decreased cardiovascular hospitalizations (14 versus 93 per 100 person-years; rate ratio 0.15; 95% CI, 0.10 to 0.23).

Study Design

Type

Meta-Analysis (n=693)

Structured PICO

Does pulmonary vein isolation improve freedom from recurrent atrial fibrillation compared to medical therapy in patients with atrial fibrillation?

P
Population
6 RCTs pooling 693 patients with atrial fibrillation
I
Intervention
Pulmonary vein isolation (catheter ablation)
C
Comparator
Medical therapy (control)
O
Outcome
Freedom from recurrent atrial fibrillation at 12 months

Main Result

Effect estimate: OR 9.74 (95% CI 3.98 to 23.87)

Absolute Event Rate: 77% vs 29%

Pulmonary vein isolation significantly increases freedom from recurrent atrial fibrillation at 1 year and reduces cardiovascular hospitalizations compared to medical therapy.

Cite This Study

Piccini et al. (2009) conducted a meta-analysis in Atrial fibrillation (n=693). Pulmonary vein isolation (PVI) vs. Medical therapy was evaluated on Freedom from recurrent AF at 12 months (OR 9.74, 95% CI 3.98 to 23.87). Pulmonary vein isolation significantly increased freedom from recurrent atrial fibrillation at 12 months compared with medical therapy (77% vs 29%; OR 9.74; 95% CI 3.98 to 23.87).

synapsesocial.com/papers/6a0f024d53f874f2b2231002https://doi.org/10.1161/circep.109.856633
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