Document Detail


Efficacy of adjunctive ablation of complex fractionated atrial electrograms and pulmonary vein isolation for the treatment of atrial fibrillation: a meta-analysis of randomized controlled trials.
MedLine Citation:
PMID:  21037322     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Although useful, percutaneous left atrial ablation for pulmonary vein isolation (PVI) does not eliminate atrial fibrillation (AF) in all patients. The ablation of complex fractionated atrial electrograms (CFAEs) has been proposed as an adjunctive strategy to improve the maintenance of sinus rhythm after PVI. Our objective was to analyse the efficacy of adjunctive CFAE ablation.
METHODS AND RESULTS: We meta-analysed six randomized controlled trials (total, n=538) using random-effects modelling to compare PVI (n=291) with PVI plus CFAE ablation (PVI+CFAE) (n=237). The primary outcome was freedom from AF or other atrial tachyarrhythmias (ATs) after a single ablation with or without antiarrhythmic drugs. Following a single ablation, PVI+CFAE improved the odds of freedom from any AF/AT compared with PVI alone (odds ratio 2.0, 95% confidence interval 1.04-3.8, P=0.04) at ≥3-month follow-up. There was moderate heterogeneity among trials (I2=63.0%). Complex fractionated atrial electrogram ablation significantly increased mean procedural (178.5±66.9 vs. 331.5±92.6 min, P<0.001), mean fluoroscopy (59.5±22.2 vs. 115.5±35.3 min, P<0.001), and mean radiofrequency (RF) energy application times (46.9±36.6 vs. 74.4±43.0 min, P<0.001).
CONCLUSIONS: Pulmonary vein isolation followed by adjunctive CFAE ablation is associated with increased freedom from AF after a single procedure. Adjunctive CFAE ablation increased procedural, fluoroscopy, and RF application times, and the risk/benefit profile of adjunctive CFAE ablation deserves further evaluation with additional studies and longer-term follow-up.
Authors:
Melissa H Kong; Jonathan P Piccini; Tristram D Bahnson
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-10-30
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  13     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-21     Completed Date:  2011-04-28     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  193-204     Citation Subset:  IM    
Affiliation:
Duke University Medical Center, Clinical Cardiac Electrophysiology Section of the Division of Cardiovascular Diseases, DUMC Box 31294, Durham, NC 27710, USA. kong0017@mc.duke.edu
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MeSH Terms
Descriptor/Qualifier:
Atrial Fibrillation / surgery*
Catheter Ablation / methods*
Electrophysiologic Techniques, Cardiac / methods*
Humans
Pulmonary Veins / surgery*
Randomized Controlled Trials as Topic
Treatment Outcome
Grant Support
ID/Acronym/Agency:
5-T32-DK-007731-15/DK/NIDDK NIH HHS
Comments/Corrections
Comment In:
Europace. 2011 Jul;13(7):909-10   [PMID:  21278148 ]
Erratum In:
Europace. 2011 Aug;13(8):1062

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