BACKGROUND: Pulmonary vein isolation (PVI) is recognized as a potentially curative treatment for atrial fibrillation (AF). Ablation of complex fractionated atrial electrograms (CFAEs) in addition to PVI has been advocated as a means to improve procedural outcomes, but the benefit remains unclear. OBJECTIVE: This study sought t synthesize the available data testing the incremental benefit of adding CFAE ablation to PVI. METHODS: We performed a meta-analysis of controlled studies comparing the effect of PVI with CFAE ablation vs. PVI alone in patients with paroxysmal and nonparoxysmal AF. RESULTS: Of the 481 reports identified, 8 studies met our inclusion criteria. There was a statistically significant increase in freedom from atrial tachyarrhythmia (AT) with the addition of CFAE ablation (relative risk [RR] 1.15, P = .03). In the 5 reports of nonparoxysmal AF (3 randomized controlled trials, 1 controlled clinical trial, and 1 trial using matched historical controls), addition of CFAE ablation resulted in a statistically significant increase in freedom from AT (n = 112 of 181 [62%] for PVI+CFAE vs. n = 84 of 179 [47%] for PVI alone; RR 1.32, P = .02). In trials of paroxysmal AF (3 randomized controlled trials and 1 trial using matched historical controls), addition of CFAE ablation did not result in a statistically significant increase in freedom from AT (n = 131 of 166 [79%] for PVI+CFAE vs. n = 122 of 164 [74%] for PVI alone; RR 1.04, P = .52). CONCLUSION: In these studies of patients with nonparoxysmal AF, addition of CFAE ablation to PVI results in greater improvement in freedom from AF. No additional benefit of this combined approach was observed in patients with paroxysmal AF.
BACKGROUND: Pulmonary vein isolation (PVI) is recognized as a potentially curative treatment for atrial fibrillation (AF). Ablation of complex fractionated atrial electrograms (CFAEs) in addition to PVI has been advocated as a means to improve procedural outcomes, but the benefit remains unclear. OBJECTIVE: This study sought t synthesize the available data testing the incremental benefit of adding CFAE ablation to PVI. METHODS: We performed a meta-analysis of controlled studies comparing the effect of PVI with CFAE ablation vs. PVI alone in patients with paroxysmal and nonparoxysmal AF. RESULTS: Of the 481 reports identified, 8 studies met our inclusion criteria. There was a statistically significant increase in freedom from atrial tachyarrhythmia (AT) with the addition of CFAE ablation (relative risk [RR] 1.15, P = .03). In the 5 reports of nonparoxysmal AF (3 randomized controlled trials, 1 controlled clinical trial, and 1 trial using matched historical controls), addition of CFAE ablation resulted in a statistically significant increase in freedom from AT (n = 112 of 181 [62%] for PVI+CFAE vs. n = 84 of 179 [47%] for PVI alone; RR 1.32, P = .02). In trials of paroxysmal AF (3 randomized controlled trials and 1 trial using matched historical controls), addition of CFAE ablation did not result in a statistically significant increase in freedom from AT (n = 131 of 166 [79%] for PVI+CFAE vs. n = 122 of 164 [74%] for PVI alone; RR 1.04, P = .52). CONCLUSION: In these studies of patients with nonparoxysmal AF, addition of CFAE ablation to PVI results in greater improvement in freedom from AF. No additional benefit of this combined approach was observed in patients with paroxysmal AF.
Authors: Moussa Mansour; Giovanni B Forleo; Augusto Pappalardo; Conor Barrett; E Kevin Heist; Andrea Avella; Gianluigi Bencardino; Antonio Dello Russo; Michela Casella; Jeremy N Ruskin; Claudio Tondo Journal: Heart Rhythm Date: 2009-12-24 Impact factor: 6.343
Authors: D F Stroup; J A Berlin; S C Morton; I Olkin; G D Williamson; D Rennie; D Moher; B J Becker; T A Sipe; S B Thacker Journal: JAMA Date: 2000-04-19 Impact factor: 56.272
Authors: Claude S Elayi; Atul Verma; Luigi Di Biase; Chi Keong Ching; Dimpi Patel; Conor Barrett; David Martin; Bai Rong; Tamer S Fahmy; Yaariv Khaykin; Richard Hongo; Steven Hao; Gemma Pelargonio; Antonio Dello Russo; Michela Casella; Pietro Santarelli; Domenico Potenza; Raffaele Fanelli; Raimondo Massaro; Mauricio Arruda; Robert A Schweikert; Andrea Natale Journal: Heart Rhythm Date: 2008-09-17 Impact factor: 6.343
Authors: Christoph Scharf; Lucas Boersma; Wyn Davies; Prapa Kanagaratnam; Nicholas S Peters; Vince Paul; Edward Rowland; Andrew Grace; Simon Fynn; Lam Dang; Hakan Oral; Fred Morady Journal: J Am Coll Cardiol Date: 2009-10-06 Impact factor: 24.094
Authors: Luigi Di Biase; Claude S Elayi; Tamer S Fahmy; David O Martin; Chi Keong Ching; Conor Barrett; Rong Bai; Dimpi Patel; Yaariv Khaykin; Richard Hongo; Steven Hao; Salwa Beheiry; Gemma Pelargonio; Antonio Dello Russo; Michela Casella; Pietro Santarelli; Domenico Potenza; Raffaele Fanelli; Raimondo Massaro; Paul Wang; Amin Al-Ahmad; Mauricio Arruda; Sakis Themistoclakis; Aldo Bonso; Antonio Rossillo; Antonio Raviele; Robert A Schweikert; David J Burkhardt; Andrea Natale Journal: Circ Arrhythm Electrophysiol Date: 2009-02-18
Authors: Hakan Oral; Aman Chugh; Kentaro Yoshida; Jean F Sarrazin; Michael Kuhne; Thomas Crawford; Nagib Chalfoun; Darryl Wells; Warangkna Boonyapisit; Srikar Veerareddy; Sreedhar Billakanty; Wai S Wong; Eric Good; Krit Jongnarangsin; Frank Pelosi; Frank Bogun; Fred Morady Journal: J Am Coll Cardiol Date: 2009-03-03 Impact factor: 24.094
Authors: Hemantha Koduri; Jason Ng; Ivan Cokic; Gary L Aistrup; David Gordon; J Andrew Wasserstrom; Alan H Kadish; Richard Lee; Rod Passman; Bradley P Knight; Jeffrey J Goldberger; Rishi Arora Journal: Circ Arrhythm Electrophysiol Date: 2012-06-21
Authors: Thomas J van Brakel; Thomas van der Krieken; Sjoerd W Westra; Jeroen A van der Laak; Joep L Smeets; Henry A van Swieten Journal: J Interv Card Electrophysiol Date: 2013-09-12 Impact factor: 1.900
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; Jose Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: J Interv Card Electrophysiol Date: 2012-03 Impact factor: 1.900