Background: Although catheter ablation (CA) by mean of pulmonary vein isolation (PVI) is nowadays the mainstay treatment for atrial fibrillation (AF), its success-rate in persistent AF remains suboptimal. Results from studies evaluating whether adding posterior wall isolation (PWI) to PVI can increase the success-rate of CA in persistent AF have yielded conflicting data. The aim of this meta-analysis was to assess whether PWI plus PVI might be beneficial in patients with persistent AF.
Methods: Electronic databases were searched for randomized control trials (RCTs) and observational studies that compared clinical outcomes between patients with persistent AF who underwent PVI with or without PWI.
Results: Fifteen studies, including a total of 3072 patients, were considered (1533 treated with PVI and 1539 with PWI + PVI). Comparing patients treated with or without PWI, no statistically significant difference was found in the risk of any atrial tachyarrhythmias recurrence after CA (RR 0.83; 95 % CI 0.66-1.03). The analyses detected a statistically significant reduction in the risk of AF in patients treated with PWI (RR 0.63; 95 % CI 0.48-0.84) balanced by a trend towards an increased risk of atrial flutter/atrial tachycardia (RR 1.51; 95 % CI 0.92-2.49). No statistically significant differences were identified in the risk of major procedural complications (RR 0.94; 95 % CI 0.50-1.78).
Conclusions: According to our updated meta-analysis, the addition of PWI to PVI was not associated with a reduction of atrial arrhythmia recurrences. A reduction of the risk of AF recurrence and a trend towards an increased risk of atrial flutter/atrial tachycardia were identified.
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A tailored substrate-based approach using focal pulsed field catheter ablation in patients with atrial fibrillation and advanced atrial substrate: Procedural data and 6-months success rates.
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View Article and Find Full Text PDFAdjunctive Left Atrial Posterior Wall Isolation in Treating Non-Paroxysmal Atrial Fibrillation: An Updated Meta-Analysis of Randomized Clinical Trials.
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Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia. Electronic address:
Article Synopsis
- - The study examines the safety and efficacy of a new 8F variable loop multielectrode catheter for pulsed field ablation (PFA) in patients with atrial fibrillation, which simplifies catheter use compared to earlier complex designs.
- - Out of 30 patients, all achieved complete pulmonary vein and posterior wall isolation, with an average procedural time of about 113 minutes and minimal complications, including a few transient cerebral lesions.
- - The research highlights that this new catheter system provides effective PFA while maintaining a safety profile similar to existing options, showing promise for future use in treating atrial fibrillation.
Persistent Atrial Fibrillation Phenotypes and Ablation Outcomes: Persistent From Outset vs Progression From Paroxysmal AF.
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The Baker Heart and Diabetes Research Institute, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia. Electronic address:
Background: Many patients with persistent atrial fibrillation (PsAF) have progressed from an initial paroxysmal phenotype; however, there are patients in whom atrial fibrillation (AF) is persistent at diagnosis. Relatively little is known about this subgroup, but prior observational studies have suggested these patients have worse outcomes with ablation.
Objectives: This study sought to: 1) assess demographic and electrophysiologic characteristics of patients with PsAF at first diagnosis compared with those with who have progressed from paroxysmal atrial fibrillation (PAF); and 2) assess the impact of pattern of AF at diagnosis on recurrence post ablation.
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