Author + information
- Sanghamitra Mohantya,b,
- Prasant Mohantya,b,
- Carola Giannia,b,
- Chintan Trivedia,b,
- Luigi Di Biasea,b and
- Andrea Natalea,b
Background: This meta-analysis systematically evaluated the outcome of pulmonary vein isolation (PVI) with and without FIRM ablation.
Methods: An extensive literature search was performed for studies reporting ≥ 1 year outcome of PVI alone and PVI+FIRM procedures. Meta-analytic estimates were derived using DerSimonian and Laird random-effects models and pooled estimates of success rate (95% CI) were computed. Statistical heterogeneity was assessed using Cochran Q test and I2. Study quality was measured using Newcastle-Ottawa Scale.
Results: Four trials with PVI+FIRM (n=302, non-randomized prospective design) and 3 PVI-only trials (n=146, randomized trials) were included in the analysis. All patients in PVI-only trials had persistent AF with no prior ablation. About 32% of PVI+FIRM population had paroxysmal AF and 51% were redo PVI. After 12±6 months, the off-AAD pooled success rate was 61% in PVI+FIRM population (95% CI 0.53-0.68) and 58% in PVI only (95% CI 0.35-0.88) (figure). On/off-AAD success rate was 69% (95% CI 0.44-0.94) and 62% (95% CI 0.38-0.85) in FIRM+PVI and PVI only populations respectively. Difference in effect size between the groups [assessed by between group variance (QB)] was not statistically significant (p=0.71). Also, there was no significant heterogeneity (negative I2 values =zero).
Conclusions: The overall pooled estimate did not show any therapeutic benefit of PVI+FIRM approach over PVI alone, which suggests the need to reevaluate the clinical utility of FIRM ablation in AF.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias and Clinical EP: AF Ablation
Abstract Category: 6. Arrhythmias and Clinical EP: Other
Presentation Number: 1150-086
- 2017 American College of Cardiology Foundation