Daniel A Gomes, Rita Reis Santos, Jorge Ferreira, Frédéric Anselme, Peter Calvert, Amand Floriaan Schmidt, Dhiraj Gupta, Serge Boveda, Pedro Adragão, Rui Providência
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The primary outcomes were any sustained atrial arrhythmia, typical AFL relapse, and AF. Secondary outcomes were need for redo-ablation or antiarrhythmic drugs. Random-effects and fixed-effects meta-analyses were undertaken for each individual outcome. Seven RCTs, with a total of 902 patients, were included. Comparing to CTI ablation alone, PVI ± CTI was more effective in preventing atrial tachyarrhythmias [risk ratio (RR) = 0.57, 95% CI: 0.41-0.79, <i>P</i> = 0.0007, <i>I</i> <sup>2</sup> = 50%, number needed to treat (NNT) = 4.1]. The results were driven mainly by a reduction of new onset/recurrent AF (RR = 0.41, 95% CI: 0.27-0.61, <i>P</i> < 0.0001, <i>I</i> <sup>2</sup> = 0%, NNT = 3.3), whereas there were no differences in typical AFL relapse (RR = 1.52, 95% CI: 0.63-3.66, <i>P</i> = 0.35, <i>I</i> <sup>2</sup> = 9%). Major complication rate was low and comparable across groups, although uncomplicated pericardial effusion was higher in PVI ± CTI (1.8% vs. 0.0%, <i>P</i> = 0.04). Results were comparable for the sub-analysis of PVI alone vs. CTI ablation.</p><p><strong>Conclusion: </strong>In patients with typical AFL, PVI ± CTI ablation is more effective than CTI alone in reducing the atrial tachyarrhythmias and subsequent AF during follow-up, without affecting major complications rate. These results set the rationale for a well-designed, larger-scale RCT comparing both strategies.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 1","pages":"oeae102"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11668177/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of pulmonary vein isolation on atrial arrhythmias in patients with typical atrial flutter: systematic review and meta-analysis of randomized clinical trials.\",\"authors\":\"Daniel A Gomes, Rita Reis Santos, Jorge Ferreira, Frédéric Anselme, Peter Calvert, Amand Floriaan Schmidt, Dhiraj Gupta, Serge Boveda, Pedro Adragão, Rui Providência\",\"doi\":\"10.1093/ehjopen/oeae102\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Cavotricuspid isthmus (CTI) ablation is the current ablation treatment for typical atrial flutter (AFL). However, post-ablation atrial tachyarrhythmias, mostly in the form of atrial fibrillation (AF), are frequently observed after CTI ablation. We aimed to evaluate the effectiveness and safety of concomitant or isolated pulmonary vein isolation (PVI) in patients with typical AFL scheduled for ablation.</p><p><strong>Methods and results: </strong>Electronic databases (PubMED, EMBASE, Clinicaltrials.gov) were searched through July, 2024. Randomized controlled trials (RCTs) were eligible if comparing PVI ± CTI ablation vs. CTI alone. The primary outcomes were any sustained atrial arrhythmia, typical AFL relapse, and AF. Secondary outcomes were need for redo-ablation or antiarrhythmic drugs. Random-effects and fixed-effects meta-analyses were undertaken for each individual outcome. Seven RCTs, with a total of 902 patients, were included. Comparing to CTI ablation alone, PVI ± CTI was more effective in preventing atrial tachyarrhythmias [risk ratio (RR) = 0.57, 95% CI: 0.41-0.79, <i>P</i> = 0.0007, <i>I</i> <sup>2</sup> = 50%, number needed to treat (NNT) = 4.1]. The results were driven mainly by a reduction of new onset/recurrent AF (RR = 0.41, 95% CI: 0.27-0.61, <i>P</i> < 0.0001, <i>I</i> <sup>2</sup> = 0%, NNT = 3.3), whereas there were no differences in typical AFL relapse (RR = 1.52, 95% CI: 0.63-3.66, <i>P</i> = 0.35, <i>I</i> <sup>2</sup> = 9%). Major complication rate was low and comparable across groups, although uncomplicated pericardial effusion was higher in PVI ± CTI (1.8% vs. 0.0%, <i>P</i> = 0.04). Results were comparable for the sub-analysis of PVI alone vs. CTI ablation.</p><p><strong>Conclusion: </strong>In patients with typical AFL, PVI ± CTI ablation is more effective than CTI alone in reducing the atrial tachyarrhythmias and subsequent AF during follow-up, without affecting major complications rate. 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引用次数: 0
摘要
目的：心尖瓣峡部（CTI）消融术是目前治疗典型心房扑动（AFL）的常用方法。然而，消融后心房性心动过速，主要以心房颤动（AF）的形式，在CTI消融后经常观察到。我们的目的是评估合并或孤立肺静脉隔离（PVI）在计划消融的典型AFL患者中的有效性和安全性。方法与结果：检索截止到2024年7月的电子数据库（PubMED、EMBASE、Clinicaltrials.gov）。如果比较PVI±CTI消融与CTI单独消融，则随机对照试验（rct）是合格的。主要结局是任何持续性心房心律失常、典型AFL复发和房颤。次要结局是需要再消融或抗心律失常药物。对每个结果进行随机效应和固定效应荟萃分析。纳入7项随机对照试验，共902例患者。与单纯CTI消融相比，PVI±CTI在预防房性心动疾速方面更有效[风险比(RR) = 0.57, 95% CI: 0.41-0.79, P = 0.0007, i2 = 50%，所需治疗人数(NNT) = 4.1]。结果主要是由于新发/复发AF的减少（RR = 0.41, 95% CI: 0.27-0.61, P < 0.0001, i2 = 0%, NNT = 3.3），而典型AFL复发没有差异（RR = 1.52, 95% CI: 0.63-3.66, P = 0.35, i2 = 9%）。虽然PVI±CTI组无并发症的心包积液发生率较高（1.8% vs. 0.0%, P = 0.04），但两组间的主要并发症发生率较低且具有可比性。单独PVI与CTI消融的亚分析结果具有可比性。结论：在典型AFL患者中，PVI±CTI消融比CTI单独消融更有效地减少了随访期间的房性心动过速和随后的房颤，且未影响主要并发症的发生率。这些结果为设计良好的、更大规模的RCT比较两种策略奠定了基础。
Impact of pulmonary vein isolation on atrial arrhythmias in patients with typical atrial flutter: systematic review and meta-analysis of randomized clinical trials.
Aims: Cavotricuspid isthmus (CTI) ablation is the current ablation treatment for typical atrial flutter (AFL). However, post-ablation atrial tachyarrhythmias, mostly in the form of atrial fibrillation (AF), are frequently observed after CTI ablation. We aimed to evaluate the effectiveness and safety of concomitant or isolated pulmonary vein isolation (PVI) in patients with typical AFL scheduled for ablation.
Methods and results: Electronic databases (PubMED, EMBASE, Clinicaltrials.gov) were searched through July, 2024. Randomized controlled trials (RCTs) were eligible if comparing PVI ± CTI ablation vs. CTI alone. The primary outcomes were any sustained atrial arrhythmia, typical AFL relapse, and AF. Secondary outcomes were need for redo-ablation or antiarrhythmic drugs. Random-effects and fixed-effects meta-analyses were undertaken for each individual outcome. Seven RCTs, with a total of 902 patients, were included. Comparing to CTI ablation alone, PVI ± CTI was more effective in preventing atrial tachyarrhythmias [risk ratio (RR) = 0.57, 95% CI: 0.41-0.79, P = 0.0007, I2 = 50%, number needed to treat (NNT) = 4.1]. The results were driven mainly by a reduction of new onset/recurrent AF (RR = 0.41, 95% CI: 0.27-0.61, P < 0.0001, I2 = 0%, NNT = 3.3), whereas there were no differences in typical AFL relapse (RR = 1.52, 95% CI: 0.63-3.66, P = 0.35, I2 = 9%). Major complication rate was low and comparable across groups, although uncomplicated pericardial effusion was higher in PVI ± CTI (1.8% vs. 0.0%, P = 0.04). Results were comparable for the sub-analysis of PVI alone vs. CTI ablation.
Conclusion: In patients with typical AFL, PVI ± CTI ablation is more effective than CTI alone in reducing the atrial tachyarrhythmias and subsequent AF during follow-up, without affecting major complications rate. These results set the rationale for a well-designed, larger-scale RCT comparing both strategies.
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