Key result
Continuous drag ablation matches point-by-point lesions for first-pass PVI while cutting procedure time by ~16 minutes.
Why the study?
The comparative efficacy of continuous drag lesion sets versus point-by-point lesion sets for pulmonary vein isolation during AF catheter ablation remained uncertain.
Does continuous drag ablation improve first pass isolation compared to point-by-point lesion sets in patients undergoing pulmonary vein isolation for atrial fibrillation?
Meta-Analysis (n=714)
Does continuous drag ablation improve first pass isolation compared to point-by-point lesion sets in patients undergoing pulmonary vein isolation for atrial fibrillation?
In atrial fibrillation catheter ablation, continuous drag lesions for pulmonary vein isolation show similar first pass isolation, 1-year arrhythmia recurrence, and complication rates compared to point-by-point ablation, while reducing total procedure time at the expense of slightly increased fluoroscopy time.
Continuous drag ablation shortens PVI procedures without first-pass isolation benefit; extends efficiency data while confirming equivalent efficacy versus point-by-point lesions.
Background Pulmonary vein isolation (PVI) is a cornerstone of AF catheter ablation. The efficacy of continuous “drag” versus point-by-point lesion sets for PVI remains uncertain; we conducted a meta-analysis. Methods An unrestricted search of Ovid MEDLINE, Embase, and Web of Science identified studies of drag versus point-by-point ablation in PVI. The primary endpoint was first pass isolation. Secondary endpoints included atrial arrhythmia recurrence at 1 year of follow-up, procedural time, ablation time, fluoroscopy time, and procedural complication rates. Results Five studies with 714 patients (324 drag, 390 point-by-point) were included. Mean follow-up was 12.9 months, age 62.1 years, CHA2DS2-VASc score 1.6, 30.4% of patients were women, and 86.3% had paroxysmal AF. Compared to point-by-point, drag lesions had no difference in first pass isolation (OR 0.86, 95% CI 0.51-1.46, p=0.57) (Figure 1a), atrial arrhythmia recurrence (OR 1.18, 95% CI 0.84-1.64, p=0.34) (Figure 1b), ablation time, or complication rates (not shown). Drag was associated with shorter procedures (mean difference 15.9 minutes, 95% CI 11.2-20.6, p<0.001) (Figure 1c), and more fluoroscopy (mean difference 2.1 minutes, 95% CI 0.99-3.3, p<0.001) (Figure 1d). Conclusion Continuous drag lesions for PVI in AF catheter ablation showed no difference in first pass isolation or atrial arrhythmia recurrence, but yielded shorter procedures despite more fluoroscopy use, with neutral effect on ablation time and complication rates.
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Chadha et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=714). Continuous drag ablation vs. Point-by-point ablation was evaluated on First pass isolation (OR 0.86, 95% CI 0.51-1.46, p=0.57). Continuous drag ablation showed no difference in first pass isolation compared to point-by-point lesions for PVI (OR 0.86, 95% CI 0.51-1.46, p=0.57), while reducing procedure time by 15.9 minutes.
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