Author + information
- Andrew Cluckeya,b,
- Fahd Yunusa,b,
- George Leefa,b,
- Mariam Askaria,b,
- Ewoud Schuita,b,
- Paul Heidenreicha,b,
- Mintu Turakhiaa,b and
- Alexander Perinoa,b
Background: We sought to define study success rates by paroxysmal atrial fibrillation (PAF) ablation lesion set and identify sources of study heterogeneity.
Methods: We performed a systematic review and meta-analysis of PAF ablation from 1/1/1990 to 8/1/2016. The protocol, registered in PROSPERO, included PAF trials and observational studies. We abstracted single procedure freedom from tachyarrhythmias off antiarrhythmic agents when reported, and analyzed groups of studies based on lesion set using multivariate meta-regression controlling for patient, procedure, and study characteristics.
Results: A total of 213 treatment arms from 158 studies (26,273 patients) met inclusion. Unadjusted success rates of ablation lesion set groups ranged from 62.2% (substrate modification) – 83.0% (pulmonary vein isolation (PVI) + substrate modification + linear ablation), with utilization of linear ablation associated with improved success as compared to PVI only (Figure). In multivariate analyses, only addition of roof lines to PVI improved success, but with small sample size and high study heterogeneity (12.5% absolute improvement, 95% CI 4.6 – 20.5%, p 0.002, I2 88%). In randomized trials (49 treatment arms), roof lines trended towards association with improved success (p 0.07, I2 82%).
Conclusions: Among studies of PAF ablation, lesion sets added to PVI appear to have minimal incremental benefit. Roof lines may provide benefit but further large, high-quality trials are needed to definitely answer the question.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Fibrillatory Arrhythmias: Outcomes With Contemporary Practice
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1110-106
- 2017 American College of Cardiology Foundation