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Meta-Analysis
. 2023 Nov 2;25(11):euad335.
doi: 10.1093/europace/euad335.

Durability of pulmonary vein isolation for atrial fibrillation: a meta-analysis and systematic review

Teodor Serban  1   2 , Diego Mannhart  1   2 , Qurrat-Ul-Ain Abid  3 , Andres Höchli  4 , Sorin Lazar  5 , Philipp Krisai  1   2 , Arianna Sofia Bettelini  1   2 , Sven Knecht  1   2 , Michael Kühne  1   2 , Christian Sticherling  1   2 , Jeanne du Fay de Lavallaz  1   2 , Patrick Badertscher  1   2
Affiliations
Meta-Analysis

Durability of pulmonary vein isolation for atrial fibrillation: a meta-analysis and systematic review

Teodor Serban et al. Europace. .

Abstract

Aims: Pulmonary vein isolation (PVI) plays a central role in the interventional treatment of atrial fibrillation (AF). Uncertainties remain about the durability of ablation lesions from different energy sources. We aimed to systematically review the durability of ablation lesions associated with various PVI-techniques using different energy sources for the treatment of AF.

Methods and results: Structured systematic database search for articles published between January 2010 and January 2023 reporting PVI-lesion durability as evaluated in the overall cohort through repeat invasive remapping during follow-up. Studies evaluating only a proportion of the initial cohort in redo procedures were excluded. A total of 19 studies investigating 1050 patients (mean age 60 years, 31% women, time to remap 2-7 months) were included. In a pooled analysis, 99.7% of the PVs and 99.4% of patients were successfully ablated at baseline and 75.5% of the PVs remained isolated and 51% of the patients had all PVs persistently isolated at follow-up across all energy sources. In a pooled analysis of the percentages of PVs durably isolated during follow-up, the estimates of RFA were the lowest of all energy sources at 71% (95% CI 69-73, 11 studies), but comparable with cryoballoon (79%, 95%CI 74-83, 3 studies). Higher durability percentages were reported in PVs ablated with laser-balloon (84%, 95%CI 78-89, one study) and PFA (87%, 95%CI 84-90, 2 studies).

Conclusion: We observed no significant difference in the durability of the ablation lesions of the four evaluated energies after adjusting for procedural and baseline populational characteristics.

Keywords: Atrial Fibrillation; Cryoballoon Ablation; Laser Balloon; Pulmonary Vein Isolation; Pulsed-Field Ablation; Radiofrequency Ablation.

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Conflict of interest statement

Conflict of interest: T.S. has received research funding from the ‘Swiss Academy of Medical Sciences’ and the ‘Gottfried & Julia Bangerter-Rhyner’ Foundation. J.F.L. has received research funding from the ‘University of Basel’ and the ‘Swiss Heart Foundation’. Philipp Krisai reports speaker fees from BMS/Pfizer. S.K. has received funding from the ‘Stiftung für Herzschrittmacher und Elektrophysiologie’. M.K. reports grants from the Swiss National Science Foundation (Grant numbers 33CS30_148474, 33CS30_177520, 32473B_176178, 32003B_197524), the Swiss Heart Foundation, the Foundation for Cardiovascular Research Basel and the University of Basel, grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants from Biotronik, grants and personal fees from Daiichi Sankyo, all outside the submitted work. C.S. is a member of the Medtronic Advisory Board Europe and Boston Scientitic Advisory Board Europe, received educational grants from Biosense Webster and Biotronik and a research grant from the European Union’s FP7 programme, and Biosense Webster and lecture and consulting fees from Abbott, Medtronic, Biosense-Webster, Boston Scientific, Microport, and Biotronik all outside the submitted work. P.B. has received research funding from the ‘University of Basel’, the Swiss Heart Foundation and Johnson & Johnson and reports personal fees from Abbott, BMS Pfizer, Boston Scientific, and Bayer, all outside the submitted work. Others have nothing to declare.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Forest plot of weighted means estimates in a per-vein analysis. CI, confidence interval; PVI, pulmonary vein isolation.
Figure 2
Figure 2
Forest plot of the estimated means of patients with all veins durably isolated at follow-up. CI, confidence interval; PV, pulmonary vein.
Figure 3
Figure 3
Estimated percentage of veins durably isolated at follow-up depending on the vein location and anatomy. CI, confidence interval, LCV, left common vein; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; PV, pulmonary vein; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein.
Figure 4
Figure 4
Evaluation of publication bias. The black and grey funnel represents the ideal study distribution (no publication bias), while the dotted funnel represents the actual study distribution. The farther away the dotted funnel from the ideal funnel is the larger the expected publication bias. The black points in the figure represent the included studies, the smaller the study, the larger the standard error.
See this image and copyright information in PMC

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