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The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta‐analysis of randomized controlled trials
BACKGROUND: Posterior wall isolation (PWI) is an emerging approach in atrial fibrillation (AF) ablation, yet its efficacy remains controversial. This is the first meta‐analysis of randomized controlled trials (RCT) to evaluate the efficacy of PWI in AF ablation. OBJECTIVE: To assess the efficacy of...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9237313/ https://www.ncbi.nlm.nih.gov/pubmed/35785381 http://dx.doi.org/10.1002/joa3.12698 |
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author | Kanitsoraphan, Chanavuth Rattanawong, Pattara Techorueangwiwat, Chol Kewcharoen, Jakrin Mekritthikrai, Raktham Prasitlumkum, Narut Shah, Parthav El Masry, Hicham |
author_facet | Kanitsoraphan, Chanavuth Rattanawong, Pattara Techorueangwiwat, Chol Kewcharoen, Jakrin Mekritthikrai, Raktham Prasitlumkum, Narut Shah, Parthav El Masry, Hicham |
author_sort | Kanitsoraphan, Chanavuth |
collection | PubMed |
description | BACKGROUND: Posterior wall isolation (PWI) is an emerging approach in atrial fibrillation (AF) ablation, yet its efficacy remains controversial. This is the first meta‐analysis of randomized controlled trials (RCT) to evaluate the efficacy of PWI in AF ablation. OBJECTIVE: To assess the efficacy of PWI in reducing atrial arrhythmia recurrence following initial AF ablation at long‐term follow‐ups when compared to conventional methods. METHODS: We conducted a literature search from inception through September 2021 in EMBASE and MEDLINE databases. We included RCTs that compared outcomes in PWI and conventional approaches of AF ablation. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratio (OR), and 95% confidence interval (CI). RESULTS: Eight RCT from 2009 to 2020, including 1024 AF patients, were included. PWI did not decrease overall atrial arrhythmias recurrence (RR 0.96, 95% CI:0.88–1.05, I (2) = 31.6%, p‐value 0.393). However, the pooled analysis showed a significant decrease in AF recurrence in PWI compared to controlled approaches (RR 0.88, 95% CI:0.81–0.96, I (2) = 48.2%, p‐value .004). In the subgroup analysis, PWI significantly decreased AF recurrence in the studies that included only persistent AF (RR = 0.89, 95% CI:0.80–0.98, I (2) = 65.2%, p‐value .014). PWI significantly decreased AF recurrence when compared to PVI with roof line (RR 0.84, 95% CI 0.74–0.95, I (2) 0.00%, p‐value .008). CONCLUSION: Our study suggests that adding PWI significantly decreased AF recurrence in patients with persistent AF compared to controlled approaches. It highlights the importance of considering PWI during the initial procedure in this patient population. |
format | Online Article Text |
id | pubmed-9237313 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92373132022-06-30 The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta‐analysis of randomized controlled trials Kanitsoraphan, Chanavuth Rattanawong, Pattara Techorueangwiwat, Chol Kewcharoen, Jakrin Mekritthikrai, Raktham Prasitlumkum, Narut Shah, Parthav El Masry, Hicham J Arrhythm Original Articles BACKGROUND: Posterior wall isolation (PWI) is an emerging approach in atrial fibrillation (AF) ablation, yet its efficacy remains controversial. This is the first meta‐analysis of randomized controlled trials (RCT) to evaluate the efficacy of PWI in AF ablation. OBJECTIVE: To assess the efficacy of PWI in reducing atrial arrhythmia recurrence following initial AF ablation at long‐term follow‐ups when compared to conventional methods. METHODS: We conducted a literature search from inception through September 2021 in EMBASE and MEDLINE databases. We included RCTs that compared outcomes in PWI and conventional approaches of AF ablation. Data from each study were combined using the random‐effects, generic inverse variance method of DerSimonian and Laird to calculate odds ratio (OR), and 95% confidence interval (CI). RESULTS: Eight RCT from 2009 to 2020, including 1024 AF patients, were included. PWI did not decrease overall atrial arrhythmias recurrence (RR 0.96, 95% CI:0.88–1.05, I (2) = 31.6%, p‐value 0.393). However, the pooled analysis showed a significant decrease in AF recurrence in PWI compared to controlled approaches (RR 0.88, 95% CI:0.81–0.96, I (2) = 48.2%, p‐value .004). In the subgroup analysis, PWI significantly decreased AF recurrence in the studies that included only persistent AF (RR = 0.89, 95% CI:0.80–0.98, I (2) = 65.2%, p‐value .014). PWI significantly decreased AF recurrence when compared to PVI with roof line (RR 0.84, 95% CI 0.74–0.95, I (2) 0.00%, p‐value .008). CONCLUSION: Our study suggests that adding PWI significantly decreased AF recurrence in patients with persistent AF compared to controlled approaches. It highlights the importance of considering PWI during the initial procedure in this patient population. John Wiley and Sons Inc. 2022-03-17 /pmc/articles/PMC9237313/ /pubmed/35785381 http://dx.doi.org/10.1002/joa3.12698 Text en © 2022 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Kanitsoraphan, Chanavuth Rattanawong, Pattara Techorueangwiwat, Chol Kewcharoen, Jakrin Mekritthikrai, Raktham Prasitlumkum, Narut Shah, Parthav El Masry, Hicham The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta‐analysis of randomized controlled trials |
title | The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta‐analysis of randomized controlled trials |
title_full | The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta‐analysis of randomized controlled trials |
title_fullStr | The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta‐analysis of randomized controlled trials |
title_full_unstemmed | The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta‐analysis of randomized controlled trials |
title_short | The efficacy of posterior wall isolation in atrial fibrillation ablation: A systematic review and meta‐analysis of randomized controlled trials |
title_sort | efficacy of posterior wall isolation in atrial fibrillation ablation: a systematic review and meta‐analysis of randomized controlled trials |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9237313/ https://www.ncbi.nlm.nih.gov/pubmed/35785381 http://dx.doi.org/10.1002/joa3.12698 |
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