Key result
Adding posterior wall isolation to persistent AF ablation reduces atrial arrhythmia recurrence by ~31%.
Why the study?
Clinical outcomes of pulmonary venous isolation alone for persistent AF remain unclear, and adjuvant posterior wall isolation has emerged as a potential supplementary ablation strategy.
Does adjuvant posterior wall isolation added to catheter ablation reduce the recurrence of atrial arrhythmias in patients with persistent atrial fibrillation?
Meta-Analysis (n=1,428)
Does adjuvant posterior wall isolation added to catheter ablation reduce the recurrence of atrial arrhythmias in patients with persistent atrial fibrillation?
Effect estimate: RR 0.69 (95% CI 0.55-0.87)
p-value: p=0.002
Adding posterior wall isolation to catheter ablation for persistent atrial fibrillation significantly reduces the recurrence of atrial arrhythmias and atrial fibrillation without increasing adverse events.
Supports adding posterior wall isolation to ablation for persistent AF; reinforces efficacy across aggregated trials without added risk.
Background The clinical outcomes of pulmonary venous isolation alone for persistent atrial fibrillation (PerAF) remain unclear. Adjuvant posterior wall isolation (PWI) has become a potential supplementary strategy for improving the outcome of PerAF ablation. This meta‐analysis aimed to evaluate the effect of PWI added to catheter ablation for PerAF. Methods PubMed, EMBASE, and Cochrane Library databases were searched for studies comparing the outcomes of PerAF ablation with and without PWI. The efficacy outcomes were recurrence of atrial arrhythmia (AA), atrial fibrillation (AF), and atrial tachycardia (AT), and the safety outcome was adverse events. Results In total, eight studies with 1428 patients were included in the pooled analyses. The results showed that PWI significantly reduced the recurrence of AA (RR = 0.69, 95% CI = 0.55–0.87, p = .002, I 2 = 63%) and AF (RR = 0.57, 95% CI = 0.40–0.80, p = .001, I 2 = 70%). AT recurrence (RR = 0.92, 95% CI = 0.67–1.27, p = .63, I 2 = 42%) and adverse events (RR = 1.11, 95% CI = 0.67–1.84, p = .70, I 2 = 0%) were comparable between the two groups. In the sub‐analyses, the efficacy of PWI in reducing AA recurrence was consistent in patients who underwent cryoablation or debulking ablation. Conclusion PWI effectively decreased AA recurrence after PerAF ablation without increasing the risk of AT or procedure‐related complications. However, more randomized studies are needed to confirm these results.
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Liu et al. (2022) conducted a meta-analysis in Persistent atrial fibrillation (PerAF) (n=1,428). Posterior wall isolation (PWI) added to catheter ablation vs. Catheter ablation without PWI was evaluated on Recurrence of atrial arrhythmia (AA) (RR 0.69, 95% CI 0.55-0.87, p=0.002). Posterior wall isolation added to catheter ablation for persistent atrial fibrillation significantly reduced the recurrence of atrial arrhythmia (RR 0.69; 95% CI 0.55–0.87; p=0.002).
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