Key result
Posterior wall isolation fails to reduce overall atrial arrhythmia recurrence versus conventional ablation in AF.
Why the study?
Posterior wall isolation is an emerging technique in atrial fibrillation ablation, but its efficacy remains controversial.
Does posterior wall isolation reduce atrial arrhythmia recurrence in patients undergoing initial atrial fibrillation ablation?
Meta-Analysis (n=1,024)
Does posterior wall isolation reduce atrial arrhythmia recurrence in patients undergoing initial atrial fibrillation ablation?
Effect estimate: RR 0.96 (95% CI 0.88-1.05)
Absolute Event Rate: 34.8% vs 36.9%
p-value: p=0.393
Adding posterior wall isolation during initial atrial fibrillation ablation reduces AF recurrence, particularly in patients with persistent AF, though it does not significantly reduce overall atrial arrhythmia recurrence.
Does not support adding posterior wall isolation to reduce overall arrhythmia recurrence in AF ablation; challenges broad benefit and leaves persistent AF effect open.
Background Posterior wall isolation (PWI) is an emerging approach in atrial fibrillation (AF) ablation, yet its efficacy remains controversial. This is the first meta‐analysis of randomized controlled trials (RCT) to evaluate the efficacy of PWI in AF ablation. Objective To assess the efficacy of PWI in reducing atrial arrhythmia recurrence following initial AF ablation at long‐term follow‐ups when compared to conventional methods. Methods We conducted a literature search from inception through September 2021 in EMBASE and MEDLINE databases. We included RCTs that compared outcomes in PWI and conventional approaches of AF ablation. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratio (OR), and 95% confidence interval (CI). Results Eight RCT from 2009 to 2020, including 1024 AF patients, were included. PWI did not decrease overall atrial arrhythmias recurrence (RR 0.96, 95% CI:0.88–1.05, I 2 = 31.6%, p‐value 0.393). However, the pooled analysis showed a significant decrease in AF recurrence in PWI compared to controlled approaches (RR 0.88, 95% CI:0.81–0.96, I 2 = 48.2%, p ‐value .004). In the subgroup analysis, PWI significantly decreased AF recurrence in the studies that included only persistent AF (RR = 0.89, 95% CI:0.80–0.98, I 2 = 65.2%, p ‐value .014). PWI significantly decreased AF recurrence when compared to PVI with roof line (RR 0.84, 95% CI 0.74–0.95, I 2 0.00%, p ‐value .008). Conclusion Our study suggests that adding PWI significantly decreased AF recurrence in patients with persistent AF compared to controlled approaches. It highlights the importance of considering PWI during the initial procedure in this patient population.
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Kanitsoraphan et al. (2022) conducted a meta-analysis in Atrial fibrillation (n=1,024). Posterior wall isolation (PWI) vs. Conventional approaches of AF ablation was evaluated on Overall atrial arrhythmias recurrence (RR 0.96, 95% CI 0.88-1.05, p=0.393). Posterior wall isolation did not significantly decrease overall atrial arrhythmias recurrence compared to conventional ablation approaches in patients with atrial fibrillation (RR 0.96).
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