Efficacy and Safety of Spatiotemporal Electrogram Dispersion Ablation With Pulmonary Vein Isolation in Persistent Atrial Fibrillation: A Meta-Analysis.

Background: Pulmonary vein isolation (PVI) is the mainstay treatment for rhythm control in patients with persistent atrial fibrillation (PsAF). However, due to the complex mechanisms of PsAF, the efficacy of PVI alone remains modest. Spatiotemporal electrogram dispersion (STED) ablation is a promising strategy to enhance outcomes. This study aims to evaluate the efficacy of STED ablation plus PVI versus PVI alone in PsAF ablation.

Methods: A systematic search was conducted to identify studies published up to November 2024 comparing PVI plus STED ablation (PVI-STED group) versus PVI alone (PVI group) in patients with PsAF. The primary outcomes were AF recurrence and sinus rhythm (SR) conversion.

Results: Eleven studies (three randomized controlled trials, three prospective cohorts, five retrospective cohorts) involving 1607 patients (mean age of 63.9 ± 9.3 years) were included. The PVI-STED group was significantly associated with a lower risk of AF recurrence (OR: 0.40, 95% CI: 0.27-0.59, I² = 25%) and a higher likelihood of SR conversion (OR: 7.04, 95% CI: 1.62-30.62, I² = 79%). No significant differences were observed in procedural time (MD: 27.61 min, 95% CI: -29.12 to 84.33, I² = 97%), ablation time (MD: 4.4 min, 95% CI: -11.3 to 20.0, I² = 98%), or fluoroscopy time (0.25 min, 95% CI: -3.4 to 3.9, I² = 95%). The overall rate of AEs in the PVI-STED group was 1% (95% CI: 1%-3%, I² = 0%).

Conclusion: The PVI-STED approach demonstrated both efficacy and safety in treating PsAF, as evidenced by reduced AF recurrence and improved SR conversion rates.