Additional ablation of complex fractionated atrial electrograms after pulmonary vein isolation in patients with atrial fibrillation: a meta-analysis
| Autor: | Yong-yi Bai, Changsheng Ma, Cai-Hua Sang, Cheng-Long Miao, Hong-yin Zhang, Xiandong Yin, Jian-Zeng Dong, Ri-Bo Tang, Wei-ju Li |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Time Factors medicine.medical_treatment Subgroup analysis Antiarrhythmic agent Pulmonary vein Predictive Value of Tests Recurrence Physiology (medical) Internal medicine Atrial Fibrillation medicine Humans Sinus rhythm business.industry Atrial fibrillation Middle Aged medicine.disease Ablation Confidence interval Surgery Treatment Outcome Pulmonary Veins Relative risk Cardiology Catheter Ablation Cardiology and Cardiovascular Medicine business Electrophysiologic Techniques Cardiac |
| Zdroj: | Circulation. Arrhythmia and electrophysiology. 4(2) |
| ISSN: | 1941-3084 |
| Popis: | Background— The efficacy of additional complex fractionated atrial electrogram (CFAE) ablation after pulmonary vein antrum isolation (PVAI) in patients with atrial fibrillation (AF) remains controversial. This meta-analysis was performed to assess the additional efficacy of CFAEs ablation after a single procedure without antiarrhythmic drugs. Methods and Results— Trials were identified in MEDLINE, Cochrane Library, Embase, Google Scholar, reviews, and reference lists of relevant papers. Controlled cohort studies comparing the long-term efficacy of combined CFAEs plus PVAI ablation with PVAI alone were included. The primary end point was the maintenance of sinus rhythm without antiarrhythmic drugs. Seven controlled trials (9 comparisons) with a total of 622 participants (332 patients underwent PVAI plus CFAE ablation and 330 patients underwent PVAI alone) were included in the meta-analysis. In an overall pooled estimate, compared with PVI alone, long-term rates of sinus rhythm maintenance (relative risk, 1.17, 95% confidence interval, 1.03 to 1.33, P =0.019) were increased by additional CFAE ablation. Subgroup analysis demonstrated that additional CFAEs ablation increased rates of sinus rhythm maintenance in nonparoxysmal AF (relative risk, 1.35; 95% confidence interval, 1.04 to 1.75; P =0.022), whereas had no effect on patients with paroxysmal AF (relative risk, 1.04; 95% confidence interval, 0.92 to 1.18; P =0.528). Conclusions— Adjuvant CFAE ablation in addition to standard PVAI increases the rate of long-term sinus rhythm maintenance in nonparoxysmal AF patients after a single procedure without antiarrhythmic drugs but does not provide additional benefit to sinus rhythm maintenance in paroxysmal AF patients. |
| Databáze: | OpenAIRE |
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