Key result
Adjunctive ablation strategies added to pulmonary vein isolation reduced the risk of atrial fibrillation recurrence by 36% at a median follow-up of 12 months (RR 0.64; 95% CI 0.48-0.85; p=0.003).
Why the study?
Does the addition of adjunctive ablation strategies to pulmonary vein isolation reduce atrial fibrillation recurrence in patients with non-paroxysmal atrial fibrillation?
Meta-Analysis (n=1,694)
Does the addition of adjunctive ablation strategies to pulmonary vein isolation reduce atrial fibrillation recurrence in patients with non-paroxysmal atrial fibrillation?
The addition of adjunctive ablation strategies to pulmonary vein isolation significantly reduces the risk of atrial fibrillation recurrence in patients with non-paroxysmal atrial fibrillation.
Supports adjunctive ablation with PVI in non-paroxysmal AF; extends pooled RCT evidence for lower recurrence.
BACKGROUND: Pulmonary vein (PV) isolation (PVI) has suboptimal outcomes in patients with non-paroxysmal atrial fibrillation (AF). Adjunctive strategies employed to ablate non-PV triggers have shown favorable outcomes. AIMS: To delineate the incremental benefit of adjunctive ablation in patients with non-paroxysmal AF through a meta-analysis. METHODS AND RESULTS: Database searches through August 2016 identified five non-randomized and seven randomized controlled trials (enrolling 1694 patients). The adjunctive strategies employed for non-PV ablation included focal impulse and rotor modulation; empirical linear lines, ablation of complex fractionated atrial electrograms and ganglionated plexi. The risk ratio (RR) for AF recurrence, calculated with random effects meta-analysis showed a 36% reduction of AF recurrence at a median follow up of 12 months (RR: 0.64, 95% Confidence interval: 0.48 to 0.85; p = 0.003). The benefits persisted during longer follow up when assessed in subgroup analysis. CONCLUSIONS: Addition of adjunctive ablation to PVI improves outcomes.
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Afzal et al. (2017) conducted a meta-analysis in Non-paroxysmal atrial fibrillation (n=1,694). Adjunctive ablation strategies (focal impulse and rotor modulation, empirical linear lines, ablation of complex fractionated atrial electrograms and ganglionated plexi) vs. Pulmonary vein isolation alone was evaluated on Atrial fibrillation recurrence (RR 0.64, 95% CI 0.48 to 0.85, p=0.003). Adjunctive ablation strategies added to pulmonary vein isolation reduced the risk of atrial fibrillation recurrence by 36% at a median follow-up of 12 months (RR 0.64; 95% CI 0.48-0.85; p=0.003).
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