Key result
Adding linear lesions to pulmonary vein isolation did not significantly reduce recurrent atrial tachyarrhythmias in patients with persistent (RR 0.73, P=0.22) or paroxysmal AF (RR 0.85, P=0.13).
Why the study?
Does the addition of linear lesions to pulmonary vein isolation reduce the recurrence of atrial tachyarrhythmias in patients with atrial fibrillation?
Meta-Analysis (n=1,446)
Does the addition of linear lesions to pulmonary vein isolation reduce the recurrence of atrial tachyarrhythmias in patients with atrial fibrillation?
Effect estimate: RR 0.73 (95% CI 0.44-1.21)
p-value: p=0.22
Adding linear ablation to pulmonary vein isolation does not improve sinus rhythm maintenance in patients with persistent or paroxysmal atrial fibrillation, but significantly increases procedure, radiofrequency, and fluoroscopy times.
Linear lesions add no benefit to PVI yet prolong procedures; challenges routine adjunctive ablation and reinforces PVI-alone strategies in future trials.
Previous studies have given conflicting data regarding the long-term adjunctive efficacy of linear lesions (LLs) on top of pulmonary vein isolation (PVI) as an ablation strategy in patients with atrial fibrillation (AF). The aim of this meta-analysis was to provide a detailed analysis of the available randomized controlled trials (RCTs) regarding the efficacy of LL following PVI in AF patients. Current databases were searched until October 2015. The primary outcome end point of the meta-analysis was recurrence of any symptomatic or documented episode of AF or atrial tachycardia after a single ablation procedure with or without the use of antiarrhythmic drugs. Ten RCTs with a total of 1,446 patients were included in the meta-analysis. The pooled analysis of five trials concerning persistent AF (PeAF) patients (400 in PVI plus LL group and 182 in PVI alone group) suggested that the addition of LL following PVI does not lead to a significant reduction in recurrent atrial tachyarrhythmias compared with PVI alone (relative ratio [RR] = 0.73, 95% confidence interval [CI]: 0.44-1.21, P = 0.22). Similarly, there was no incremental benefit of additional LL in long-term outcomes in paroxysmal AF (PAF) patients (RR = 0.85, 95% CI: 0.68-1.05, P = 0.13). Pooling the results of all eligible trials suggested that PVI plus LL compared with PVI alone significantly increased radiofrequency time (P = 0.0002), fluoroscopy time (P < 0.00001), and procedure time (P < 0.0001). This meta-analysis suggests that LL following PVI does not provide additional benefit to sinus rhythm maintenance in patients with PeAF and PAF.
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Zhang et al. (2016) conducted a meta-analysis in Atrial Fibrillation (n=1,446). Linear lesions following pulmonary vein isolation vs. Pulmonary vein isolation alone was evaluated on Recurrence of any symptomatic or documented episode of AF or atrial tachycardia after a single ablation procedure (RR 0.73, 95% CI 0.44-1.21, p=0.22). Adding linear lesions to pulmonary vein isolation did not significantly reduce recurrent atrial tachyarrhythmias in patients with persistent (RR 0.73, P=0.22) or paroxysmal AF (RR 0.85, P=0.13).
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