Adding left atrial posterior wall isolation to pulmonary vein isolation during pulsed-field ablation did not reduce atrial tachyarrhythmia recurrence (OR 0.78; 95% CI 0.50-1.21; P=0.27).
Meta-Analysis (n=882)
Does left atrial posterior wall isolation in addition to pulmonary vein isolation using a pentaspline catheter in pulsed-field ablation reduce atrial tachyarrhythmia recurrence in patients with atrial fibrillation?
Adding left atrial posterior wall isolation to pulmonary vein isolation during pulsed-field ablation for atrial fibrillation is feasible but does not significantly reduce atrial tachyarrhythmia recurrence.
Effect estimate: OR 0.78 (95% CI 0.50-1.21)
p-value: p=0.27
BACKGROUND Persistent atrial fibrillation (AF) may require extensive ablation strategies.Left atrial posterior wall isolation (LAPWI) might address potential substrates for recurrence during pulsedfield ablation (PFA).OBJECTIVE This meta-analysis aimed to investigate the feasibility and effectiveness of LAPWI in addition to pulmonary vein isolation (PVI) using a pentaspline catheter in PFA for AF.METHODS Comprehensive search was conducted using PubMed, SCOPUS, ScienceDirect, and EuropePMC for studies reporting LAP-WI1PVI using a pentaspline catheter in PFA ablation for AF.The primary outcome was atrial tachyarrhythmia (ATa) recurrence, defined as AF/atrial flutter/atrial tachycardia after blanking period.RESULTS There were 882 patients from 7 studies.The success rate of LAPWI was 100% using mean/median of 16 to 20 added PFA applications with no reported acute left atrial posterior wall reconnection and esophageal complications.In mean follow-up of 240 6 91 days, ATa recurrence was 21% (95% CI 13%-29%; I 2 5 84.8%) in the LAPWI1PVI group.Meta-regression analysis showed that age, left ventricular ejection fraction, and repeat procedure did not significantly influence ATa recurrence (P ..05).Each 1-mm increase in left atrial diameter, increases the chance of ATa recurrence by 6% (R 2 5 100%, P , .001,I 2 5 0%).Meta-analysis showed no difference in terms of ATa recurrence among LAPWI1PVI patients compared with those without LAPWI (odds ratio 0.78, 95% confidence interval 0.50-1.21,P 5 .27;I 2 5 0%, P 5 .86).Procedure time and fluoroscopy time did not significantly differ (P ..05).CONCLUSION LAPWI using a pentaspline catheter during PFA was feasible and did not prolong the procedure/fluoroscopy but did not reduce ATa recurrence.LAPWI may be considered during PFA, although the benefit is uncertain.
Pranata et al. (Sat,) conducted a meta-analysis in Atrial fibrillation (n=882). Left atrial posterior wall isolation (LAPWI) plus pulmonary vein isolation (PVI) vs. PVI without LAPWI was evaluated on Atrial tachyarrhythmia (ATa) recurrence (OR 0.78, 95% CI 0.50-1.21, p=0.27). Adding left atrial posterior wall isolation to pulmonary vein isolation during pulsed-field ablation did not reduce atrial tachyarrhythmia recurrence (OR 0.78; 95% CI 0.50-1.21; P=0.27).