Key result
Ablation including pulmonary vein isolation significantly reduced the recurrence of atrial fibrillation and atrial tachycardia by 46% compared to ablation without pulmonary vein isolation.
Why the study?
PVI efficacy has usually been judged against anti-arrhythmic drugs in open-label trials, but RCTs where both arms received ablation with or without PVI may provide a more rigorous evaluation.
Does an ablation strategy including pulmonary vein isolation prevent atrial fibrillation recurrence in patients with atrial fibrillation compared to an ablation strategy excluding pulmonary vein isolation?
Meta-Analysis (n=610)
Does an ablation strategy including pulmonary vein isolation prevent atrial fibrillation recurrence in patients with atrial fibrillation compared to an ablation strategy excluding pulmonary vein isolation?
In patients undergoing ablation for atrial fibrillation, the inclusion of pulmonary vein isolation significantly reduces AF recurrence compared to ablation strategies omitting PVI.
Answers are grounded in this paper and cite their sources.
Supports including pulmonary vein isolation in atrial fibrillation ablation; confirms 46% recurrence reduction in randomized evidence.
OBJECTIVES: This meta-analysis examined the ability of pulmonary vein isolation (PVI) to prevent atrial fibrillation in randomized controlled trials (RCTs) in which the patients not receiving PVI nevertheless underwent a procedure. BACKGROUND: PVI is a commonly used procedure for the treatment of atrial fibrillation (AF), and its efficacy has usually been judged against therapy with anti-arrhythmic drugs in open-label trials. There have been several RCTs of AF ablation in which both arms received an ablation, but the difference between the treatment arms was inclusion or omission of PVI. These trials of an ablation strategy with PVI versus an ablation strategy without PVI may provide a more rigorous method for evaluating the efficacy of PVI. METHODS: Medline and Cochrane databases were searched for RCTs comparing ablation including PVI with ablation excluding PVI. The primary efficacy endpoint was freedom from atrial fibrillation (AF) and atrial tachycardia at 12 months. A random-effects meta-analysis was performed using the restricted maximum likelihood estimator. RESULTS: 78%). CONCLUSIONS: In RCTs where both arms received an ablation, and therefore an expectation amongst patients and doctors of benefit, being randomized to PVI had a striking effect, reducing AF recurrence by a half.
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Sau et al. (2019) conducted a meta-analysis in Atrial fibrillation (n=610). Ablation including Pulmonary Vein Isolation (PVI) vs. Ablation excluding PVI was evaluated on Recurrence of atrial fibrillation and atrial tachycardia at 12 months (RR 0.54, 95% CI 0.33-0.89, p=0.0147). Ablation including pulmonary vein isolation significantly reduced the recurrence of atrial fibrillation and atrial tachycardia by 46% compared to ablation without pulmonary vein isolation.
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