Clinical impact of posterior wall isolation in catheter ablation for persistent atrial fibrillation: A systematic review and meta-analysis.

Pacing and clinical electrophysiology : PACE Pub Date : 2022-10-01 Epub Date: 2022-09-20 DOI:10.1111/pace.14591
Xiaohua Liu, Xiaofei Gao, Lian Chen, Lishui Shen, Meijun Liu, Yizhou Xu
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Abstract

Background: The clinical outcomes of pulmonary venous isolation alone for persistent atrial fibrillation (PerAF) remain unclear. Adjuvant posterior wall isolation (PWI) has become a potential supplementary strategy for improving the outcome of PerAF ablation. This meta-analysis aimed to evaluate the effect of PWI added to catheter ablation for PerAF.

Methods: PubMed, EMBASE, and Cochrane Library databases were searched for studies comparing the outcomes of PerAF ablation with and without PWI. The efficacy outcomes were recurrence of atrial arrhythmia (AA), atrial fibrillation (AF), and atrial tachycardia (AT), and the safety outcome was adverse events.

Results: In total, eight studies with 1428 patients were included in the pooled analyses. The results showed that PWI significantly reduced the recurrence of AA (RR = 0.69, 95% CI = 0.55-0.87, p = .002, I2  = 63%) and AF (RR = 0.57, 95% CI = 0.40-0.80, p = .001, I2  = 70%). AT recurrence (RR = 0.92, 95% CI = 0.67-1.27, p = .63, I2  = 42%) and adverse events (RR = 1.11, 95% CI = 0.67-1.84, p = .70, I2  = 0%) were comparable between the two groups. In the sub-analyses, the efficacy of PWI in reducing AA recurrence was consistent in patients who underwent cryoablation or debulking ablation.

Conclusion: PWI effectively decreased AA recurrence after PerAF ablation without increasing the risk of AT or procedure-related complications. However, more randomized studies are needed to confirm these results.

后壁隔离对持续性房颤导管消融的临床影响:一项系统回顾和荟萃分析。
背景:单独肺静脉隔离治疗持续性心房颤动(PerAF)的临床结果尚不清楚。辅助后壁隔离(PWI)已成为改善PerAF消融结果的潜在补充策略。本荟萃分析旨在评估PWI加入导管消融治疗PerAF的效果。方法:检索PubMed、EMBASE和Cochrane图书馆数据库,比较有PWI和没有PWI的PerAF消融结果的研究。疗效终点为房性心律失常(AA)、心房颤动(AF)和房性心动过速(AT)复发,安全性终点为不良事件。结果:共纳入8项研究,1428例患者。结果显示,PWI可显著降低AA (RR = 0.69, 95% CI = 0.55 ~ 0.87, p = 0.002, I2 = 63%)和AF (RR = 0.57, 95% CI = 0.40 ~ 0.80, p = 0.001, I2 = 70%)的复发率。两组AT复发率(RR = 0.92, 95% CI = 0.67-1.27, p = 0.63, I2 = 42%)和不良事件发生率(RR = 1.11, 95% CI = 0.67-1.84, p = 0.70, I2 = 0%)具有可比性。在亚组分析中,PWI减少AA复发的疗效在接受冷冻消融或减积消融的患者中是一致的。结论:PWI可有效降低PerAF消融后AA复发,且不增加AT或手术相关并发症的风险。然而,需要更多的随机研究来证实这些结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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