Key result
Low-voltage area ablation in addition to pulmonary vein isolation reduced atrial arrhythmia recurrence (OR 0.65; 95% CI 0.52-0.81; p < 0.001), with a number needed to treat of 10.
Why the study?
Low-voltage area ablation in addition to pulmonary vein isolation has been proposed for atrial fibrillation, but clinical trials have yielded conflicting results.
Does low-voltage area ablation in addition to pulmonary vein isolation reduce atrial arrhythmia recurrence in patients with atrial fibrillation?
Systematic Review and Meta-Analysis (n=1,547)
Does low-voltage area ablation in addition to pulmonary vein isolation reduce atrial arrhythmia recurrence in patients with atrial fibrillation?
Odds Ratio: 0.65 (95% CI 0.52–0.81)
Number Needed to Treat: 10
p-value: p=< 0.001
Adding low-voltage area ablation to pulmonary vein isolation significantly reduces atrial arrhythmia recurrence in patients with atrial fibrillation without increasing procedure time or complications.
Supports adjunctive LVA ablation to reduce AF recurrence; extends conflicting RCT data by confirming benefit without added procedural risk.
Background: Low-voltage area (LVA) ablation, in addition to pulmonary vein isolation (PVI), has been proposed as a new strategy in patients with atrial fibrillation (AF), but clinical trials have shown conflicting results. We performed a systematic review and meta-analysis to assess the impact of LVA ablation in patient undergoing AF ablation (PROSPERO-registered CRD42024537696). Methods: Randomized clinical trials investigating the role of LVA ablation in addition to PVI in patients with AF were searched on PubMed, Embase, and the Cochrane Library from inception to 22 April 2024. Primary outcome was atrial arrhythmia recurrence after the first AF ablation procedure. Secondary endpoints included procedure time, fluoroscopy time, and procedure-related complication rate. Sensitivity analysis including only patients with LVA demonstration at mapping and multiple subgroups analyses were also performed. Results: 1547 patients from 7 studies were included. LVA ablation in addition to PVI reduced atrial arrhythmia recurrence (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.52–0.81, p < 0.001) with a number needed to treat to prevent recurrence of 10. No difference in procedure time (mean difference [MD] −5.32 min, 95% CI −19.01–8.46 min, p = 0.45), fluoroscopy time (MD −1.10 min, 95% CI −2.48–0.28 min, p = 0.12) and complication rate (OR 0.81, 95% CI 0.40–1.61, p = 0.54) was observed. Consistent results were demonstrated when considering only patients with LVA during mapping and in prespecified subgroups for AF type (paroxysmal vs. persistent), multicentric vs. monocentric trial, and ablation strategy in control group. Conclusions: In patients with AF, ablation of LVAs in addition to PVI reduces atrial arrhythmia recurrence without a significant increase in procedure time, fluoroscopy time, or complication rate.
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Valcher et al. (2024) conducted a systematic review and meta-analysis in Atrial fibrillation (AF) (n=1,547). Low-voltage area (LVA) ablation in addition to pulmonary vein isolation (PVI) vs. Pulmonary vein isolation (PVI) alone was evaluated on Atrial arrhythmia recurrence after the first AF ablation procedure (OR 0.65, 95% CI 0.52-0.81, p=< 0.001). Low-voltage area ablation in addition to pulmonary vein isolation reduced atrial arrhythmia recurrence (OR 0.65; 95% CI 0.52-0.81; p < 0.001), with a number needed to treat of 10.
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