Left atrial posterior wall isolation reduces the recurrence of atrial fibrillation: a meta-analysis

Abstract

Purpose: The posterior wall of left atrium plays an important role in atrial fibrillation (AF) recurrence, but the benefit of left atrial posterior wall isolation (PWI) remains still unclear. The objective was to evaluate the benefit of PWI in radiofrequency ablation.

Methods: PubMed and the Web of Science were searched in September 2015. Studies comparing catheter ablation with PWI [PWI(+)] vs. ablation without PWI [PWI(-)] were included. We performed a meta-analysis to assess atrial arrhythmia recurrence, procedure-related complications, and procedural time.

Results: Five studies with 594 AF patients were included. Compared with PWI(-), PWI(+) resulted in a significantly lower atrial arrhythmia recurrence rate (relative risk [RR] 0.81, 95 % confidence interval [CI] 0.68-0.97, p = 0.02), which was largely driven by the decreased AF recurrence (RR 0.55, 95 % CI 0.35-0.86, p = 0.009). Recurrence rates of atrial tachycardia/flutter (AT/AFL) were comparable between two groups (RR 1.16, 95 % CI 0.85-1.58, p = 0.34). There were no significant differences in procedure-related complications (RR 1.07, 95 % CI 0.45-2.53, p = 0.89) and procedural times (weight mean difference 0.88, 95 % CI -7.29-9.06, p = 0.83).

Conclusions: This meta-analysis shows that with comparable procedure-related complications and procedural time, ablation with PWI reduces AF recurrence.

Keywords: Atrial fibrillation; Left atrial posterior wall isolation; Meta-analysis; Pulmonary vein isolation; Radiofrequency ablation.