Adjunctive complex fractionated atrial electrogram ablation plus pulmonary vein isolation improved freedom from atrial tachyarrhythmias compared to PVI alone (OR 2.0; 95% CI 1.04-3.8; P=0.04).
Meta-Analysis (n=538)
Does adjunctive CFAE ablation added to PVI improve freedom from atrial fibrillation or other atrial tachyarrhythmias in patients with atrial fibrillation?
Adjunctive CFAE ablation combined with PVI significantly increases freedom from atrial arrhythmias compared to PVI alone, though at the cost of longer procedural and fluoroscopy times.
Effect estimate: OR 2.0 (95% CI 1.04-3.8)
p-value: p=0.04
AIMS: Although useful, percutaneous left atrial ablation for pulmonary vein isolation (PVI) does not eliminate atrial fibrillation (AF) in all patients. The ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as an adjunctive strategy to improve the maintenance of sinus rhythm after PVI. Our objective was to analyse the efficacy of adjunctive CFAE ablation. METHODS AND RESULTS: We meta-analysed six randomized controlled trials (total, n=538) using random-effects modelling to compare PVI (n=291) with PVI plus CFAE ablation (PVI+CFAE) (n=237). The primary outcome was freedom from AF or other atrial tachyarrhythmias (ATs) after a single ablation with or without antiarrhythmic drugs. Following a single ablation, PVI+CFAE improved the odds of freedom from any AF/AT compared with PVI alone (odds ratio 2.0, 95% confidence interval 1.04-3.8, P=0.04) at ≥3-month follow-up. There was moderate heterogeneity among trials (I2=63.0%). Complex fractionated atrial electrogram ablation significantly increased mean procedural (178.5±66.9 vs. 331.5±92.6 min, P<0.001), mean fluoroscopy (59.5±22.2 vs. 115.5±35.3 min, P<0.001), and mean radiofrequency (RF) energy application times (46.9±36.6 vs. 74.4±43.0 min, P<0.001). CONCLUSIONS: Pulmonary vein isolation followed by adjunctive CFAE ablation is associated with increased freedom from AF after a single procedure. Adjunctive CFAE ablation increased procedural, fluoroscopy, and RF application times, and the risk/benefit profile of adjunctive CFAE ablation deserves further evaluation with additional studies and longer-term follow-up.
Kong et al. (Sat,) conducted a meta-analysis in Atrial fibrillation (n=538). Pulmonary vein isolation plus complex fractionated atrial electrogram ablation (PVI+CFAE) vs. Pulmonary vein isolation (PVI) alone was evaluated on Freedom from AF or other atrial tachyarrhythmias (ATs) after a single ablation with or without antiarrhythmic drugs (OR 2.0, 95% CI 1.04-3.8, p=0.04). Adjunctive complex fractionated atrial electrogram ablation plus pulmonary vein isolation improved freedom from atrial tachyarrhythmias compared to PVI alone (OR 2.0; 95% CI 1.04-3.8; P=0.04).
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