Sharan Prakash Sharma1, Rajbir S Sangha2, Khagendra Dahal3, Parasuram Krishnamoorthy4. 1. University of New England, LRGHealthcare, 80 Highland Street, Laconia, NH, 03246, USA. ssharma@lrgh.org. 2. Clinical Cardiac Electrophysiology, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. 3. University of New England, LRGHealthcare, 80 Highland Street, Laconia, NH, 03246, USA. 4. Division of Cardiology, Albert Einstein Medical Center, Philadelphia, PA, USA.
Abstract
BACKGROUND: It is not clear whether additional empiric superior vena cava isolation (SVCI) to pulmonary vein isolation (PVI) results in low recurrences of atrial fibrillation. We aimed to perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated role of empiric SVCI in atrial fibrillation ablation. METHODS: We searched PubMed, EMBASE, Cochrane, Scopus, and relevant references for RCTs (inception April 15, 2016 without language restrictions) and performed meta-analysis using random effects model. Recurrence rates of atrial fibrillations, procedural times, fluoroscopic times, and adverse events were the measured outcomes. RESULTS: Three RCTs with a total population of 526 were analyzed. There was no difference in the recurrence rate between PVI plus SVCI versus PVI alone when comparison was made across all types of AF (39 vs 60; odds ratio 0.68; 95 % CI 0.43-1.07; P = 0.73; I 2 = 0 %). When analysis was restricted only to paroxysmal AF, there was a trend towards low recurrence rate in combination group without statistical significance (19 vs 35, OR 0.54; 95 % CI 0.29-1.00; P = 0.05; I 2 = 0). Similarly, no difference was noted between two groups in procedural (weighted mean difference [WMD] 10.12; 95 % CI -9.84 to 30.08; P = 0.32; I 2 = 85 %) and fluoroscopic time (WMD 4.66; 95 % CI -0.92 to 10.25; P = 0.1; I 2 = 94). Adverse events were similar in both groups. CONCLUSION: Empiric SVCI does not provide additional benefit to PVI alone for atrial fibrillation ablation.
BACKGROUND: It is not clear whether additional empiric superior vena cava isolation (SVCI) to pulmonary vein isolation (PVI) results in low recurrences of atrial fibrillation. We aimed to perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated role of empiric SVCI in atrial fibrillation ablation. METHODS: We searched PubMed, EMBASE, Cochrane, Scopus, and relevant references for RCTs (inception April 15, 2016 without language restrictions) and performed meta-analysis using random effects model. Recurrence rates of atrial fibrillations, procedural times, fluoroscopic times, and adverse events were the measured outcomes. RESULTS: Three RCTs with a total population of 526 were analyzed. There was no difference in the recurrence rate between PVI plus SVCI versus PVI alone when comparison was made across all types of AF (39 vs 60; odds ratio 0.68; 95 % CI 0.43-1.07; P = 0.73; I 2 = 0 %). When analysis was restricted only to paroxysmal AF, there was a trend towards low recurrence rate in combination group without statistical significance (19 vs 35, OR 0.54; 95 % CI 0.29-1.00; P = 0.05; I 2 = 0). Similarly, no difference was noted between two groups in procedural (weighted mean difference [WMD] 10.12; 95 % CI -9.84 to 30.08; P = 0.32; I 2 = 85 %) and fluoroscopic time (WMD 4.66; 95 % CI -0.92 to 10.25; P = 0.1; I 2 = 94). Adverse events were similar in both groups. CONCLUSION: Empiric SVCI does not provide additional benefit to PVI alone for atrial fibrillation ablation.
Authors: Susan Colilla; Ann Crow; William Petkun; Daniel E Singer; Teresa Simon; Xianchen Liu Journal: Am J Cardiol Date: 2013-07-04 Impact factor: 2.778
Authors: Evan L Thacker; Barbara McKnight; Bruce M Psaty; W T Longstreth; Sascha Dublin; Paul N Jensen; Katherine M Newton; Nicholas L Smith; David S Siscovick; Susan R Heckbert Journal: J Gen Intern Med Date: 2012-09-13 Impact factor: 5.128
Authors: Ivan Zeljkovic; Sven Knecht; Florian Spies; Tobias Reichlin; Stefan Osswald; Michael Kühne; Christian Sticherling Journal: J Interv Card Electrophysiol Date: 2020-01-07 Impact factor: 1.900
Authors: Sven Knecht; Ivan Zeljkovic; Michael Kühne; Christian Sticherling; Patrick Badertscher; Philipp Krisai; Florian Spies; Jan Vognstrup; Nikola Pavlovic; Sime Manola; Stefan Osswald Journal: J Interv Card Electrophysiol Date: 2022-08-18 Impact factor: 1.759
Authors: Andrew Cluckey; Alexander C Perino; Fahd N Yunus; George C Leef; Mariam Askari; Paul A Heidenreich; Sanjiv M Narayan; Paul J Wang; Mintu P Turakhia Journal: J Am Heart Assoc Date: 2019-01-08 Impact factor: 5.501