Key result
Prophylactic pulmonary vein isolation during cavotricuspid isthmus ablation significantly reduced recurrent atrial arrhythmias at 1 year compared to CTI alone (OR 0.25; 95% CI 0.14-0.44; P<0.00001).
Why the study?
Atrial arrhythmias often occur after cavotricuspid isthmus ablation for typical atrial flutter, but the overall effect of performing concomitant prophylactic pulmonary vein isolation remained to be determined.
Does prophylactic PVI during CTI ablation reduce recurrent atrial arrhythmias in patients with typical atrial flutter?
Meta-Analysis (n=550)
Does prophylactic PVI during CTI ablation reduce recurrent atrial arrhythmias in patients with typical atrial flutter?
Odds Ratio: 0.25 (95% CI 0.14–0.44)
p-value: p=<0.00001
Prophylactic PVI during CTI ablation for typical atrial flutter significantly reduces recurrent atrial arrhythmias at 1 year without increasing major complications.
May support adding prophylactic PVI to CTI ablation; extends combined ablation evidence with RCT data.
BACKGROUND: Atrial arrhythmias (AA), including atrial fibrillation (AF), have been reported in patients after cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFL). Several studies have examined the effect of performing concomitant pulmonary vein isolation (PVI) with CTI on recurrent AA. These studies were analyzed to determine the overall effect of this approach on recurrent AA. METHODS: PubMed and Google Scholar were searched for randomized trials comparing the incidence of AA after CTI versus CTI + PVI until June 2018. Only patients without prior history of AF were included in the recurrent AA analysis. All patients were included in the analyses of other clinical outcomes. RESULTS: Four randomized control trials were included in the meta-analysis. In the recurrent AA analysis, a total of 314 patients were randomized in the studies (n = 158 CTI, n = 156 CTI + PVI). Freedom from AA at 1 year was significantly higher in the CTI + PVI group versus CTI alone (odds ratio [OR] 0.25 [0.14, 0.44] 95% confidence interval [CI], P < 0.00001). A total of 550 patients (n = 336 CTI, n = 214 CTI + PVI) were included in analyses for procedure time, fluoroscopy time, and complications rates. Procedure time and fluoroscopy time were significantly longer in the CTI + PVI group (mean difference [MD]: 103.31 min [94.40, 112.23] 95% CI, P < 0.00001) and (MD: 16.47 min [14.89, 18.05] 95% CI, P < 0.00001), respectively. Total complications were statistically similar between groups. CONCLUSION: This meta-analysis shows addition of a prophylactic PVI during CTI ablation significantly reduces recurrent AA at 1 year without significantly increasing major complications.
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Koerber et al. (2019) conducted a meta-analysis in Typical atrial flutter (n=550). Concomitant pulmonary vein isolation (PVI) with cavotricuspid isthmus (CTI) ablation vs. CTI ablation alone was evaluated on Recurrent atrial arrhythmias at 1 year (OR 0.25, 95% CI 0.14-0.44, p=<0.00001). Prophylactic pulmonary vein isolation during cavotricuspid isthmus ablation significantly reduced recurrent atrial arrhythmias at 1 year compared to CTI alone (OR 0.25; 95% CI 0.14-0.44; P<0.00001).
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