Key result
Steerable sheaths for AF ablation reduce arrhythmia recurrence ~48% versus non-steerable sheaths.
Why the study?
Steerable sheaths have been widely used in radiofrequency catheter ablation of atrial fibrillation, but their comparative efficacy and safety versus non-steerable sheaths needed evaluation.
Does the use of steerable sheaths reduce the recurrence of atrial fibrillation and acute pulmonary vein reconnection in patients undergoing radiofrequency ablation compared to non-steerable sheaths?
Meta-Analysis (n=518)
Does the use of steerable sheaths reduce the recurrence of atrial fibrillation and acute pulmonary vein reconnection in patients undergoing radiofrequency ablation compared to non-steerable sheaths?
The use of steerable sheaths during radiofrequency ablation for atrial fibrillation significantly reduces the recurrence of arrhythmias and acute pulmonary vein reconnection compared to non-steerable sheaths, without affecting procedural times.
Steerable sheaths merit consideration for AF ablation to lower recurrence; confirms benefit across pooled studies without increasing procedural time.
OBJECTIVES: With the development of radiofrequency (RF) ablation technology. In recent years, more and more patients with atrial fibrillation (AF) have been treated with RF ablation. Steerable sheaths (SS) have been widely used in RF ablation of AF. The aim of this meta-analysis was to compare the efficacy and safety of AF ablation using SS and non-steerable sheaths (NSS). METHODS: From the beginning to March 2022, we conducted a comprehensive, systematic search of the databases PubMed, MEDLINE, EMBASE, Web of Science and the Cochrane Library to finish the study. For categorical and continuous data, we used ORs and mean difference to calculate the effect. We also estimated the 95% CI. RESULTS: Five studies of RF ablation of AF were selected, three prospective and two retrospective, involving 282 SS and 236 NSS ablation patients. The rate of recurrence of AF or atrial arrhythmias was 27.3% versus 42.8% (OR: 0.52, 95% CI 0.36, 0.76, z=3.41, p=0.0006) and acute pulmonary vein (PV) reconnection (8.7% vs 17.4%, OR: 0.47, 95% CI 0.23, 0.95, z=2.10, p=0.04). In the SS group and the NSS group, the total ablation time (p=0.25), fluoroscopy time (p=0.26) and total operative time (p=0.35) were not significantly different. CONCLUSIONS: Compared with the use of NSS, the use of SS for RF ablation of AF can effectively reduce the recurrence rate of AF and the occurrence of acute PVs reconnection events. However, there is no advantage in shortening the total RF time, fluoroscopy time, total surgical time and reducing complications.
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Jin et al. (2023) conducted a meta-analysis in Atrial fibrillation (n=518). Steerable sheaths vs. Non-steerable sheaths was evaluated on Recurrence of AF or atrial arrhythmias (OR 0.52, 95% CI 0.36-0.76, p=0.0006). Steerable sheaths for atrial fibrillation ablation reduced the recurrence of AF or atrial arrhythmias compared to non-steerable sheaths (27.3% vs 42.8%; OR 0.52; 95% CI 0.36-0.76; p=0.0006).
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