Key result
Adding posterior wall isolation to PVI during PFA fails to reduce atrial tachyarrhythmia recurrence.
Why the study?
Persistent AF may require extensive ablation strategies, and LAPWI might address substrates for recurrence during pulsed-field ablation, but its feasibility and effectiveness remained to be investigated.
Does left atrial posterior wall isolation in addition to pulmonary vein isolation using a pentaspline catheter in pulsed-field ablation reduce atrial tachyarrhythmia recurrence in patients with atrial fibrillation?
Meta-Analysis (n=882)
Does left atrial posterior wall isolation in addition to pulmonary vein isolation using a pentaspline catheter in pulsed-field ablation reduce atrial tachyarrhythmia recurrence in patients with atrial fibrillation?
Adding left atrial posterior wall isolation to pulmonary vein isolation during pulsed-field ablation for atrial fibrillation is feasible but does not significantly reduce atrial tachyarrhythmia recurrence.
Does not support adding posterior wall isolation to PVI during pulsed-field ablation; leaves open the need for randomized trials.
BACKGROUND Persistent atrial fibrillation (AF) may require extensive ablation strategies.Left atrial posterior wall isolation (LAPWI) might address potential substrates for recurrence during pulsedfield ablation (PFA).OBJECTIVE This meta-analysis aimed to investigate the feasibility and effectiveness of LAPWI in addition to pulmonary vein isolation (PVI) using a pentaspline catheter in PFA for AF.METHODS Comprehensive search was conducted using PubMed, SCOPUS, ScienceDirect, and EuropePMC for studies reporting LAP-WI1PVI using a pentaspline catheter in PFA ablation for AF.The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after blanking period.RESULTS There were 882 patients from 7 studies.The success rate of LAPWI was 100% using mean/median of 16 to 20 added PFA applications with no reported acute left atrial posterior wall reconnection and esophageal complications.In mean follow-up of 240 6 91 days, ATa recurrence was 21% (95% CI 13%-29%; I 2 5 84.8%) in the LAPWI1PVI group.Meta-regression analysis showed that age, left ventricular ejection fraction, and repeat procedure did not significantly influence ATa recurrence (P ..05).Each 1-mm increase in left atrial diameter, increases the chance of ATa recurrence by 6% (R 2 5 100%, P , .001,I 2 5 0%).Meta-analysis showed no difference in terms of ATa recurrence among LAPWI1PVI patients compared with those without LAPWI (odds ratio 0.78, 95% confidence interval 0.50-1.21,P 5 .27;I 2 5 0%, P 5 .86).Procedure time and fluoroscopy time did not significantly differ (P ..05).CONCLUSION LAPWI using a pentaspline catheter during PFA was feasible and did not prolong the procedure/fluoroscopy but did not reduce ATa recurrence.LAPWI may be considered during PFA, although the benefit is uncertain.
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Pranata et al. (2024) conducted a meta-analysis in Atrial fibrillation (n=882). Left atrial posterior wall isolation (LAPWI) plus pulmonary vein isolation (PVI) vs. PVI without LAPWI was evaluated on Atrial tachyarrhythmia (ATa) recurrence (OR 0.78, 95% CI 0.50-1.21, p=0.27). Adding left atrial posterior wall isolation to pulmonary vein isolation during pulsed-field ablation did not reduce atrial tachyarrhythmia recurrence (OR 0.78; 95% CI 0.50-1.21; P=0.27).
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