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Meta-Analysis
. 2011 Feb;13(2):193-204.
doi: 10.1093/europace/euq384. Epub 2010 Oct 30.

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

Melissa H Kong  1 , Jonathan P Piccini, Tristram D Bahnson
Affiliations
Meta-Analysis

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

Melissa H Kong et al. Europace. 2011 Feb.

Erratum in

  • Europace. 2011 Aug;13(8):1062

Abstract

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.

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Figures

Figure 1
Figure 1
QUOROM flow diagram for the meta-analysis.
Figure 2
Figure 2
Freedom from AF/AT at post-procedure follow-up. Odds ratios for PVI vs. PVI + CFAE.
Figure 3
Figure 3
Mean procedural, fluoroscopy, and RF energy application times. Comparison of PVI vs. PVI + CFAE.
See this image and copyright information in PMC

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